Ccgerson
Guest
Can 23472 and 23430 both be reported for this surgery? There is an edit, however in reading several articles, they both can be reported under certain circumstances. It looks like two incisions were made, I'm not sure if that's enough to justify both codes. Thank you!
A deltopectoral approach was used. The cephalic vein was identified and retracted laterally with the deltoid. The deltopectoral interval was opened down through the clavipectoral fascia. The conjoined tendon was retracted medially and the deltoid was retracted laterally. The extra nerve was identified and protected. A biceps tenodesis was performed in situ using #2 FiberWire suture. A longitudinal incision was made in the subscapularis tendon leaving a small cuff of lateral tissue for repair. The tendon was sutured tagged. The rotator cuff interval was opened slightly. With the axillary nerve being protected digitally, the capsule was released inferiorly off the humeral head. The biceps tendon was transected at the entrance into the glenohumeral joint and that area was scarified. The humeral head was exposed with straight retractors posteriorly and inferiorly along the superior double angle retractor. The humeral head was cut using an reciprocating saw after a template was used to mark the cut. The cut was made according to the patient's anatomic axis. A proximal humeral protector was placed on the bone followed by a Sonnabend retractor posteriorly and a 3 prong retractor anteriorly. The glenoid was nicely exposed and the biceps stump and labrum was excised with the Bovie circumferentially. A 40 mm trial glenoid was placed on and the central guidewire was drilled. Once the position was optimal the low profile reamers were used followed by a hand reamer followed by the central anchor peg drill. The anchor peg template was then used to place the superior and 2 inferior local drill sites. The 40 mm trial anchor peg glenoid was placed and found to be acceptable. Cement was mixed on the back table and the glenoid was prepared using pulse lavage fluid containing bacitracin along with epinephrine-soaked pledgets for the lug holes. Once the cement was ready it was placed into tuberculin syringes and injected into the lug holes. The central peg of the anchor peg glenoid component was packed with bone autograft around the fins and the implant was then placed and held securely until cement hardened. Attention was turned back to the proximal humerus where the hand reamers were used up to a size 8 followed by broaches up to a size 8. A 44 x 21 mm eccentric head was chosen to be most acceptable. Trial components removed and the bone was prepared with pulsatile should continue bacitracin. A pressfit size 8 humeral stem was placed followed by the 44 x 21 mm eccentric humeral head. The implant was impacted into final position. Final range of motion was checked and acceptable.
A deltopectoral approach was used. The cephalic vein was identified and retracted laterally with the deltoid. The deltopectoral interval was opened down through the clavipectoral fascia. The conjoined tendon was retracted medially and the deltoid was retracted laterally. The extra nerve was identified and protected. A biceps tenodesis was performed in situ using #2 FiberWire suture. A longitudinal incision was made in the subscapularis tendon leaving a small cuff of lateral tissue for repair. The tendon was sutured tagged. The rotator cuff interval was opened slightly. With the axillary nerve being protected digitally, the capsule was released inferiorly off the humeral head. The biceps tendon was transected at the entrance into the glenohumeral joint and that area was scarified. The humeral head was exposed with straight retractors posteriorly and inferiorly along the superior double angle retractor. The humeral head was cut using an reciprocating saw after a template was used to mark the cut. The cut was made according to the patient's anatomic axis. A proximal humeral protector was placed on the bone followed by a Sonnabend retractor posteriorly and a 3 prong retractor anteriorly. The glenoid was nicely exposed and the biceps stump and labrum was excised with the Bovie circumferentially. A 40 mm trial glenoid was placed on and the central guidewire was drilled. Once the position was optimal the low profile reamers were used followed by a hand reamer followed by the central anchor peg drill. The anchor peg template was then used to place the superior and 2 inferior local drill sites. The 40 mm trial anchor peg glenoid was placed and found to be acceptable. Cement was mixed on the back table and the glenoid was prepared using pulse lavage fluid containing bacitracin along with epinephrine-soaked pledgets for the lug holes. Once the cement was ready it was placed into tuberculin syringes and injected into the lug holes. The central peg of the anchor peg glenoid component was packed with bone autograft around the fins and the implant was then placed and held securely until cement hardened. Attention was turned back to the proximal humerus where the hand reamers were used up to a size 8 followed by broaches up to a size 8. A 44 x 21 mm eccentric head was chosen to be most acceptable. Trial components removed and the bone was prepared with pulsatile should continue bacitracin. A pressfit size 8 humeral stem was placed followed by the 44 x 21 mm eccentric humeral head. The implant was impacted into final position. Final range of motion was checked and acceptable.
