Desperate Denise
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If anyone could help me please code this one?
For the revision of the rotator cuff repair arthroscopically - 29827-22 but then for the open core decompression I was thinking of using the unlisted code for open shoulder surgery.
Thanks in advance guys - getting a lot of tough ones these days!!
OPERATION PERFORMED:
1. Left shoulder arthroscopy.
2. Left shoulder revision rotator cuff repair - recurrent rotator cuff tear
3. Left shoulder core decompression - avascular necrosis humeral head
The area of the previous arthroscopic
incision was marked posteriorly. A mark was made 5 cm down from the
lateral aspect of the acromion to insure that the axillary nerve was
protected throughout the case and then the arthroscope was introduced in
the posterior aspect of the glenohumeral joint and diagnostic arthroscopy
was begun. There was softening of the cartilage over the humeral head but
no evidence of frank collapse. There was no evidence of concomitant
changes on the glenoid surface. Biceps tendon was in good condition.
There was evidence of a high-grade partial thickness rotator cuff tear
involving the supraspinatus tendon. Infraspinatus tendon was intact. No
evidence of loose bodies within the axillary pouch. An anterior portal
was made using an outside-in technique. An 18 gauge spinal needle was
inserted above the superior border of the subscapularis muscle. An 11
blade scalpel was used to incise the skin. A 7-0 cannula from Arthrex was
introduced in the glenohumeral joint. The humeral head articular
cartilage was probed. It was felt to be stable. An arthroscopic shaver
was placed on the rotator cuff tear for debridement interarticularly. It
was marked with an 0 Prolene stitch. Then the arthroscope was introduced
in the subacromial space. A lateral portal was established approximately
3 fingerbreadths down from the anterior lateral aspect of the acromion and
a 7-0 cannula from Arthrex was introduced in the subacromial space. There
was evidence of a full-thickness rotator cuff tear with previous
arthroscopic stitches. The previous arthroscopic stitches were removed.
The edges of the rotator cuff tear were debrided using arthroscopic
shaver. The greater tuberosity footprint was cleared of all soft tissues
using arthroscopic shaver as well as the ArthroCare wand and decorticated
using a 4-0 acromionizer bur. An anterior portal was established. A
single side-to-side stitch was placed and then a single 5.5 Helix anchor
was placed in the greater tuberosity footprint. Each limb of the Helix
anchor was passed through the rotator cuff tissue. The stitches were tied
in a sequential fashion using ____________ x6. Once the rotator cuff
repair was complete, the core decompression of the case was performed.
The arm was brought into slight abduction. Using the 7-0 cannula, this
was brought down to the lateral aspect of the humerus. Under fluoroscopic
image in the AP plane, a guidewire for the biotenodesis kit was advanced
under fluoroscopic image to the subchondral plate in the area of the
avascular necrosis area on MRI. The position of the guidewire was then
checked in the axillary view. It was felt to be slightly posterior. A
second Steinmann pin was placed just anterior to that in the same plane.
First the Steinmann pin was removed. Using the second Steinmann pin and
the 4 mm biotenodesis cannulated drill, drilling of the subchondral plate
was performed using this 4.0 cannulated drill. Gentle manipulation of the
drill both anterior and posterior was used to confirm that the sclerotic
area was fully decompressed. Venous bleeding was seen through the cannula after decompression. Care was taken to preserve the subchondral plate which was confirmed after decompression was complete.
For the revision of the rotator cuff repair arthroscopically - 29827-22 but then for the open core decompression I was thinking of using the unlisted code for open shoulder surgery.
Thanks in advance guys - getting a lot of tough ones these days!!
OPERATION PERFORMED:
1. Left shoulder arthroscopy.
2. Left shoulder revision rotator cuff repair - recurrent rotator cuff tear
3. Left shoulder core decompression - avascular necrosis humeral head
The area of the previous arthroscopic
incision was marked posteriorly. A mark was made 5 cm down from the
lateral aspect of the acromion to insure that the axillary nerve was
protected throughout the case and then the arthroscope was introduced in
the posterior aspect of the glenohumeral joint and diagnostic arthroscopy
was begun. There was softening of the cartilage over the humeral head but
no evidence of frank collapse. There was no evidence of concomitant
changes on the glenoid surface. Biceps tendon was in good condition.
There was evidence of a high-grade partial thickness rotator cuff tear
involving the supraspinatus tendon. Infraspinatus tendon was intact. No
evidence of loose bodies within the axillary pouch. An anterior portal
was made using an outside-in technique. An 18 gauge spinal needle was
inserted above the superior border of the subscapularis muscle. An 11
blade scalpel was used to incise the skin. A 7-0 cannula from Arthrex was
introduced in the glenohumeral joint. The humeral head articular
cartilage was probed. It was felt to be stable. An arthroscopic shaver
was placed on the rotator cuff tear for debridement interarticularly. It
was marked with an 0 Prolene stitch. Then the arthroscope was introduced
in the subacromial space. A lateral portal was established approximately
3 fingerbreadths down from the anterior lateral aspect of the acromion and
a 7-0 cannula from Arthrex was introduced in the subacromial space. There
was evidence of a full-thickness rotator cuff tear with previous
arthroscopic stitches. The previous arthroscopic stitches were removed.
The edges of the rotator cuff tear were debrided using arthroscopic
shaver. The greater tuberosity footprint was cleared of all soft tissues
using arthroscopic shaver as well as the ArthroCare wand and decorticated
using a 4-0 acromionizer bur. An anterior portal was established. A
single side-to-side stitch was placed and then a single 5.5 Helix anchor
was placed in the greater tuberosity footprint. Each limb of the Helix
anchor was passed through the rotator cuff tissue. The stitches were tied
in a sequential fashion using ____________ x6. Once the rotator cuff
repair was complete, the core decompression of the case was performed.
The arm was brought into slight abduction. Using the 7-0 cannula, this
was brought down to the lateral aspect of the humerus. Under fluoroscopic
image in the AP plane, a guidewire for the biotenodesis kit was advanced
under fluoroscopic image to the subchondral plate in the area of the
avascular necrosis area on MRI. The position of the guidewire was then
checked in the axillary view. It was felt to be slightly posterior. A
second Steinmann pin was placed just anterior to that in the same plane.
First the Steinmann pin was removed. Using the second Steinmann pin and
the 4 mm biotenodesis cannulated drill, drilling of the subchondral plate
was performed using this 4.0 cannulated drill. Gentle manipulation of the
drill both anterior and posterior was used to confirm that the sclerotic
area was fully decompressed. Venous bleeding was seen through the cannula after decompression. Care was taken to preserve the subchondral plate which was confirmed after decompression was complete.