Tanya.DeSimone
Contributor
Please help....any and all opinions are welcome.
My surgeon performed a right shoulder hemiarthroplasty and a glenoid reconstruction with humeral head autograft for a chronic anterior fracture dislocation.
I want to bill for the hemi with 23470 and the unlisted for the glenoid reconstruction and humeral head autograft.....but am looking for opinions about "compare" codes. I have no idea where to start.
Here's the procedure note.....
A deltopectoral incision was made. Dissection taken down to the deltoid pectoral groove. Cephalic vein was isolated, retracted medially. The humeral head could not be relocated even under anesthesia. The strap muscles were retracted medially. The biceps tendon was dissected out of its groove and the rotator interval opened. The subscabularis was peeled off the lesser tuberosity leaving a small 1 cm cuff for reattachement. An attempt was made to dislocate the humeral head, which it was. However, the humeral head defect was approximately 50% of the head. Therefore, it was deemed unable to be bone grafted. A hemiarthroplasty was decided on at this point.
A humeral osteotomy was then used and cut in 30 degrees of retroversion. At this point, the glenoid was exposed. However, a large anterior portion of the glonoid was found to be deficient due to the chronic anterior dislocation. The posterior capsule was release as it was tight. The anterior neck was exposed. The humeral head was then fashioned as an allograft and placed into the defect of the anterior glenoid, recreating the glenoid surface. Two 4-0 cannulated screws within the guidewires were drilled, measured and a 40 and a 38 screw were then placed securing the autograft in place. At this point, the humerus was reamed up to a size 15. A trial broach was inserted and the humerus was trialed. A size 42 sphericity head had apporximate 50% excursion inferiorly. Posteriorly it was midly tight. However, it was stable and would not dislocate anteriorly. At this point, the wounds were copiously irrigated again. A total of 4 fiber wires were placed through the humeral shaft, drilled throughfor approximation of the subscapularis tendon. The actual stem which is a size 15 anatomic Zimmer hemiarthrolasty stem was impacted in place. The humeral head was then trialed and the final size was a 46 mm x 15 mm humeral head. Off-center, eccentric head was impacted. Shoulder was then reduced and trialed and was stable. The subscapularis was then closed and the rotator interval closed and the biceps tendon tenodesed. At this point, the wounds were copiously irrigated again, 2+0 Vicrylsubcu and a running Biosyn stitch. Hemovac drain placed........
My surgeon performed a right shoulder hemiarthroplasty and a glenoid reconstruction with humeral head autograft for a chronic anterior fracture dislocation.
I want to bill for the hemi with 23470 and the unlisted for the glenoid reconstruction and humeral head autograft.....but am looking for opinions about "compare" codes. I have no idea where to start.
Here's the procedure note.....
A deltopectoral incision was made. Dissection taken down to the deltoid pectoral groove. Cephalic vein was isolated, retracted medially. The humeral head could not be relocated even under anesthesia. The strap muscles were retracted medially. The biceps tendon was dissected out of its groove and the rotator interval opened. The subscabularis was peeled off the lesser tuberosity leaving a small 1 cm cuff for reattachement. An attempt was made to dislocate the humeral head, which it was. However, the humeral head defect was approximately 50% of the head. Therefore, it was deemed unable to be bone grafted. A hemiarthroplasty was decided on at this point.
A humeral osteotomy was then used and cut in 30 degrees of retroversion. At this point, the glenoid was exposed. However, a large anterior portion of the glonoid was found to be deficient due to the chronic anterior dislocation. The posterior capsule was release as it was tight. The anterior neck was exposed. The humeral head was then fashioned as an allograft and placed into the defect of the anterior glenoid, recreating the glenoid surface. Two 4-0 cannulated screws within the guidewires were drilled, measured and a 40 and a 38 screw were then placed securing the autograft in place. At this point, the humerus was reamed up to a size 15. A trial broach was inserted and the humerus was trialed. A size 42 sphericity head had apporximate 50% excursion inferiorly. Posteriorly it was midly tight. However, it was stable and would not dislocate anteriorly. At this point, the wounds were copiously irrigated again. A total of 4 fiber wires were placed through the humeral shaft, drilled throughfor approximation of the subscapularis tendon. The actual stem which is a size 15 anatomic Zimmer hemiarthrolasty stem was impacted in place. The humeral head was then trialed and the final size was a 46 mm x 15 mm humeral head. Off-center, eccentric head was impacted. Shoulder was then reduced and trialed and was stable. The subscapularis was then closed and the rotator interval closed and the biceps tendon tenodesed. At this point, the wounds were copiously irrigated again, 2+0 Vicrylsubcu and a running Biosyn stitch. Hemovac drain placed........