cclarson
Guru
I'm probably way overthinking this, but one of our doctors performed arthroscopic debridement of arthrofibrosis of a patient's shoulder w/ manipulation. Now normally I'd code this as 29825, but there is no clear indication of adhesions. So would I code it as 29822 or 29825 for the debridement?
Here is the report:
POSTOPERATIVE DIAGNOSES:
Left shoulder posterior labral tear, with arthrofibrosis.
OPERATION PERFORMED:
Left shoulder extensive debridement with manipulation under anesthesia.
INDICATIONS:
A 65-year-old male with a history of frozen shoulder on the right, complaints of increasing left shoulder pain. He has got an MRI showing a posterior labral tear. He does have symptoms consistent with that. He does have a painful arc of motion, which makes his examination difficult, so he did not appear to have an arthrofibrotic shoulder. He presents for his left shoulder posterior labral repair.
DESCRIPTION OF PROCEDURE:
He was taken to the OR and placed in the supine position on the operating room table. After the administration of anesthesia, he was positioned in the right lateral decubitus position. He was prepped and draped in the usual fashion.
After surgical timeout, a posterior portal was made. The sheath was placed in the shoulder over a blunt trocar. An anterior portal was made under direct visualization.
A routine arthroscopy was performed. The first thing noticed was it was tight and had very inflamed synovium throughout his shoulder. His posterior-inferior labrum had a small tear, but was not displaced and was relatively stable. I removed the traction and performed an examination under anesthesia and confirmed that he had an obvious arthrofibrosis. I did get 80 degrees of glenohumeral abduction but only about 80 degrees of forward flexion. I manipulated his shoulder and got 180 degrees of forward flexion. I then was able to get his external rotation from about 50 degrees prior to manipulation to 90 degrees after manipulation. I placed the scope back in the shoulder. It was much easier to manipulate the scope lateral to the shoulder at this point. I used a shaver through the anterior portal and debrided very inflamed synovium. The labrum was still stable. I felt that it was not wise to try to repair the labrum in face of this significant arthrofibrosis, particularly when the labral tear was rather small. The procedure was completed. The portals were closed with nylon. It was dressed with Xeroform, sterile gauze, ABDs, and tape. He was placed in a sling. He was awakened and taken from the OR in stable condition.
Here is the report:
POSTOPERATIVE DIAGNOSES:
Left shoulder posterior labral tear, with arthrofibrosis.
OPERATION PERFORMED:
Left shoulder extensive debridement with manipulation under anesthesia.
INDICATIONS:
A 65-year-old male with a history of frozen shoulder on the right, complaints of increasing left shoulder pain. He has got an MRI showing a posterior labral tear. He does have symptoms consistent with that. He does have a painful arc of motion, which makes his examination difficult, so he did not appear to have an arthrofibrotic shoulder. He presents for his left shoulder posterior labral repair.
DESCRIPTION OF PROCEDURE:
He was taken to the OR and placed in the supine position on the operating room table. After the administration of anesthesia, he was positioned in the right lateral decubitus position. He was prepped and draped in the usual fashion.
After surgical timeout, a posterior portal was made. The sheath was placed in the shoulder over a blunt trocar. An anterior portal was made under direct visualization.
A routine arthroscopy was performed. The first thing noticed was it was tight and had very inflamed synovium throughout his shoulder. His posterior-inferior labrum had a small tear, but was not displaced and was relatively stable. I removed the traction and performed an examination under anesthesia and confirmed that he had an obvious arthrofibrosis. I did get 80 degrees of glenohumeral abduction but only about 80 degrees of forward flexion. I manipulated his shoulder and got 180 degrees of forward flexion. I then was able to get his external rotation from about 50 degrees prior to manipulation to 90 degrees after manipulation. I placed the scope back in the shoulder. It was much easier to manipulate the scope lateral to the shoulder at this point. I used a shaver through the anterior portal and debrided very inflamed synovium. The labrum was still stable. I felt that it was not wise to try to repair the labrum in face of this significant arthrofibrosis, particularly when the labral tear was rather small. The procedure was completed. The portals were closed with nylon. It was dressed with Xeroform, sterile gauze, ABDs, and tape. He was placed in a sling. He was awakened and taken from the OR in stable condition.
