peporter
Guru
Hello coders, I have attached op notes for a arthroscopic shoulder surgery. I have codes for everything except the chrondroplasty with abrasion-plasty of the glenoid. I'm thinking it might be inclusive to one of the other procedures but could use some help. I have coded this:
29827
29807
29826
29824
29823
Any suggestions? Thanks again, Paula
PROCEDURE
1. Left shoulder arthroscopy with rotator cuff repair.
2. Left shoulder arthroscopy with labral repair.
3. Left shoulder arthroscopy with subacromial decompression through
separate fascial plane.
4. Left shoulder arthroscopy with distal clavicle excision through
separate fascial plane.
5. Left shoulder arthroscopy with chondroplasty with abrasion-plasty
of the glenoid.
6. Left shoulder arthroscopy with extensive debridement of joint.
DESCRIPTION OF PROCEDURE
Patient seen in preop holding by department of orthopedics and
anesthesia, at which time she identified the left upper extremity as the
appropriate extremity for the procedure. I placed my initials on the
extremity for identification. She was given IV antibiotics
preoperatively for prophylaxis. Taken back to the OR suite and placed
supine on a well-padded table. She is administered regional block by
anesthesia for postop pain relief. She is then placed under general
anesthesia without complication. She was then placed in a beach-chair
position again with all bony processes well-padded. Left upper
extremity was sterilely prepped and draped in normal fashion. A
standard posterior portal was made through the skin with a scalpel.
Blunt trocar and cannulas placed in the glenohumeral joint posteriorly.
There is some fraying of the glenoid, and there was a large articular
cartilage lesion with a flap tear of the anteroinferior glenoid. A
separate anterior portal was created using an outside-in technique
through the interval. A probe was placed, and there was a 1-cm flap
cartilage lesion of the anteroinferior glenoid. Chondroplasty was
completed on this to a stable border. This was done to bare bone.
There was also some labral tearing around this area. The rotator cuff
appeared to be intact, anterior to posterior. There was some labral
fraying around the removed glenoid with remainder of the glenoid intact.
The shaver was placed in the joint, and the joint was extensively
debrided. Since the patient did have a labral tear around the area of
cartilage injury, I was going to advance the labrum over the cartilage
injury to help this heal in. I placed 1 cannula in the anterior portal.
I placed a guide for the Arthrex anchor in the defect and then drilled
and placed in a 3.5 bioabsorbable anchor. This was tapped into place.
A suture passer was taken around the glenoid inferiorly, and one of the
suture limbs was passed through the labrum. Sliding knot half-hitches
were used to tie down the labrum into the cartilage defect. This
covered over nicely. The suture limbs were cut with an arthroscopic
cutter. The humeral head did not have any significant articular
cartilage lesions. There are no loose bodies in the axillary pouch.
The biceps labral complex was intact superiorly. Once this was
completed, the instruments were withdrawn. Subacromial space was
entered posteriorly with the scope. A separate lateral incision was
made, and a shaver was placed in the subacromial space. There was a
significant amount of inflammation and bursitis. This was removed with
a shaver. Thermal wand by ArthroCare was then taken through the lateral
portal, and the soft tissue on the undersurface of the acromion was
released as well as the coracoacromial ligament anterolaterally. This
revealed a large spur. A bur was taken to remove the spur. The
decompression was completed. The AC joint could now be seen, and this
is severely arthritic with inferior spurring causing impingement. A
separate fascial plane through the anterior portal was created and a bur
was used to resect 1 cm of distal clavicle. Care was taken to preserve
the capsule ligamentous structures superiorly and posteriorly. Once
this was completed, the rotator cuff was inspected. There was a 90%
bursal-sided tear approximately 1 cm of the supraspinatus but more
posteriorly. This was debrided and completed. The insertion was
separate fascial plane through the anterior portal was created and a bur
was used to resect 1 cm of distal clavicle. Care was taken to preserve
the capsule ligamentous structures superiorly and posteriorly. Once
this was completed, the rotator cuff was inspected. There was a 90%
bursal-sided tear approximately 1 cm of the supraspinatus but more
posteriorly. This was debrided and completed. The insertion was
prepared with the bur. A separate posterolateral incision was made off
the acromion, and a punch was placed in the insertion where the rotator
cuff was torn. The punch was used, and then a 5.5 fully-threaded
Corkscrew anchor by Arthrex was screwed into place. The suture limbs
were passed through the cuff with a Scorpion suture passer in a simple
manner. The arm was abducted and sutures were tied down with a sliding
knot and half-hitches. The suture was then cut. This was an excellent
repair of the rotator cuff back to its insertion. This was probed and
felt to be very stable. The remainder of the subacromial space was
irrigated out with a shaver. The instruments were withdrawn, and
portals were closed with suture. Local anesthetic was injected. A
sterile dressing was applied as well as a cold therapy pack over the
gown. The patient's arm was placed in an immobilizer. The patient then
awoken from anesthesia without complication and transferred to the post
anesthesia care unit in stable condition.
29827
29807
29826
29824
29823
Any suggestions? Thanks again, Paula
PROCEDURE
1. Left shoulder arthroscopy with rotator cuff repair.
2. Left shoulder arthroscopy with labral repair.
3. Left shoulder arthroscopy with subacromial decompression through
separate fascial plane.
4. Left shoulder arthroscopy with distal clavicle excision through
separate fascial plane.
5. Left shoulder arthroscopy with chondroplasty with abrasion-plasty
of the glenoid.
6. Left shoulder arthroscopy with extensive debridement of joint.
DESCRIPTION OF PROCEDURE
Patient seen in preop holding by department of orthopedics and
anesthesia, at which time she identified the left upper extremity as the
appropriate extremity for the procedure. I placed my initials on the
extremity for identification. She was given IV antibiotics
preoperatively for prophylaxis. Taken back to the OR suite and placed
supine on a well-padded table. She is administered regional block by
anesthesia for postop pain relief. She is then placed under general
anesthesia without complication. She was then placed in a beach-chair
position again with all bony processes well-padded. Left upper
extremity was sterilely prepped and draped in normal fashion. A
standard posterior portal was made through the skin with a scalpel.
Blunt trocar and cannulas placed in the glenohumeral joint posteriorly.
There is some fraying of the glenoid, and there was a large articular
cartilage lesion with a flap tear of the anteroinferior glenoid. A
separate anterior portal was created using an outside-in technique
through the interval. A probe was placed, and there was a 1-cm flap
cartilage lesion of the anteroinferior glenoid. Chondroplasty was
completed on this to a stable border. This was done to bare bone.
There was also some labral tearing around this area. The rotator cuff
appeared to be intact, anterior to posterior. There was some labral
fraying around the removed glenoid with remainder of the glenoid intact.
The shaver was placed in the joint, and the joint was extensively
debrided. Since the patient did have a labral tear around the area of
cartilage injury, I was going to advance the labrum over the cartilage
injury to help this heal in. I placed 1 cannula in the anterior portal.
I placed a guide for the Arthrex anchor in the defect and then drilled
and placed in a 3.5 bioabsorbable anchor. This was tapped into place.
A suture passer was taken around the glenoid inferiorly, and one of the
suture limbs was passed through the labrum. Sliding knot half-hitches
were used to tie down the labrum into the cartilage defect. This
covered over nicely. The suture limbs were cut with an arthroscopic
cutter. The humeral head did not have any significant articular
cartilage lesions. There are no loose bodies in the axillary pouch.
The biceps labral complex was intact superiorly. Once this was
completed, the instruments were withdrawn. Subacromial space was
entered posteriorly with the scope. A separate lateral incision was
made, and a shaver was placed in the subacromial space. There was a
significant amount of inflammation and bursitis. This was removed with
a shaver. Thermal wand by ArthroCare was then taken through the lateral
portal, and the soft tissue on the undersurface of the acromion was
released as well as the coracoacromial ligament anterolaterally. This
revealed a large spur. A bur was taken to remove the spur. The
decompression was completed. The AC joint could now be seen, and this
is severely arthritic with inferior spurring causing impingement. A
separate fascial plane through the anterior portal was created and a bur
was used to resect 1 cm of distal clavicle. Care was taken to preserve
the capsule ligamentous structures superiorly and posteriorly. Once
this was completed, the rotator cuff was inspected. There was a 90%
bursal-sided tear approximately 1 cm of the supraspinatus but more
posteriorly. This was debrided and completed. The insertion was
separate fascial plane through the anterior portal was created and a bur
was used to resect 1 cm of distal clavicle. Care was taken to preserve
the capsule ligamentous structures superiorly and posteriorly. Once
this was completed, the rotator cuff was inspected. There was a 90%
bursal-sided tear approximately 1 cm of the supraspinatus but more
posteriorly. This was debrided and completed. The insertion was
prepared with the bur. A separate posterolateral incision was made off
the acromion, and a punch was placed in the insertion where the rotator
cuff was torn. The punch was used, and then a 5.5 fully-threaded
Corkscrew anchor by Arthrex was screwed into place. The suture limbs
were passed through the cuff with a Scorpion suture passer in a simple
manner. The arm was abducted and sutures were tied down with a sliding
knot and half-hitches. The suture was then cut. This was an excellent
repair of the rotator cuff back to its insertion. This was probed and
felt to be very stable. The remainder of the subacromial space was
irrigated out with a shaver. The instruments were withdrawn, and
portals were closed with suture. Local anesthetic was injected. A
sterile dressing was applied as well as a cold therapy pack over the
gown. The patient's arm was placed in an immobilizer. The patient then
awoken from anesthesia without complication and transferred to the post
anesthesia care unit in stable condition.
