Desperate Denise
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Blue Shield sent a note stating that I cannot submit the arthroscopic subacromial decompression with the mini-open rotator cuff repair - I was under the impression that you could - they are saying it is incidental.
Any input will be appreciated:
Thank you in advance for any comments.
POSTOPERATIVE DIAGNOSIS: Right shoulder rotator cuff repair.
PROCEDURE: Right shoulder arthroscopy, subacromial debridement, mini
open rotator cuff repair, and insertion of anesthetic catheter.
INDICATIONS: The patient is a 52-year-old with complaints of pain in
her right shoulder. Risks and benefits of surgery were discussed with
the patient including bleeding, infection, nerve or artery damage,
failure to improve her pain, need for further surgery, and she wished
to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room and placed supine on the operating room table. After induction
of interscalene block, she was placed in the beach chair position.
All bony prominences were padded. Her right shoulder was prepped and
draped in the standard surgical fashion. A posterior portal was
created. Examination of the joint showed a normal subscapularis
tendon. There was a tear of the supraspinatus, split anteriorly over
the biceps, extending posteriorly into the infraspinatus. The
infraspinatus and teres minor were intact posteriorly. The biceps
anchor and the labrum were intact. Attention was directed to the
subacromial space where this was confirmed after debriding the tissue.
The mini open incision was chosen. Dissection was carried down
through skin and subcutaneous tissue. The rotator cuff was identified
and the edges were debrided. The greater tuberosity was debrided.
The #2 FiberWire was used to close the rotator interval anteriorly
covering the biceps tendon. A 5.5 peak anchor was placed into the
greater tuberosity and the rotator cuff tendon was brought back to the
tuberosity posteriorly. The humeral head was covered at the
conclusion of the case. The shoulder was irrigated and the pain pump
catheter was inserted at this point.
Any input will be appreciated:
Thank you in advance for any comments.
POSTOPERATIVE DIAGNOSIS: Right shoulder rotator cuff repair.
PROCEDURE: Right shoulder arthroscopy, subacromial debridement, mini
open rotator cuff repair, and insertion of anesthetic catheter.
INDICATIONS: The patient is a 52-year-old with complaints of pain in
her right shoulder. Risks and benefits of surgery were discussed with
the patient including bleeding, infection, nerve or artery damage,
failure to improve her pain, need for further surgery, and she wished
to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating
room and placed supine on the operating room table. After induction
of interscalene block, she was placed in the beach chair position.
All bony prominences were padded. Her right shoulder was prepped and
draped in the standard surgical fashion. A posterior portal was
created. Examination of the joint showed a normal subscapularis
tendon. There was a tear of the supraspinatus, split anteriorly over
the biceps, extending posteriorly into the infraspinatus. The
infraspinatus and teres minor were intact posteriorly. The biceps
anchor and the labrum were intact. Attention was directed to the
subacromial space where this was confirmed after debriding the tissue.
The mini open incision was chosen. Dissection was carried down
through skin and subcutaneous tissue. The rotator cuff was identified
and the edges were debrided. The greater tuberosity was debrided.
The #2 FiberWire was used to close the rotator interval anteriorly
covering the biceps tendon. A 5.5 peak anchor was placed into the
greater tuberosity and the rotator cuff tendon was brought back to the
tuberosity posteriorly. The humeral head was covered at the
conclusion of the case. The shoulder was irrigated and the pain pump
catheter was inserted at this point.