Arthroscopy w glenoid fx repair?

peporter

Guru
Messages
106
Location
Columbus, OH
Best answers
0
Good morning Coders, I need your help with this surgery. How would you code the fracture repair? Do I need to use an unlisted code or is it inclusive of one of the other arthroscopic procedures? Thanks in advance for your help. Paula

1. Left shoulder arthroscopy with fixation of glenoid fracture.
2. Left shoulder arthroscopy with anterior capsulorrhaphy.
3. Left shoulder arthroscopy with anterior labral repair.
4. Left shoulder arthroscopy with extensive debridement of joint.
5. Vitagel soft tissue autograft insertion, left shoulder wound.

ANESTHESIA
General with regional block.

INDICATIONS
The patient is a 31-year-old male who was seen previously in the office
with above preop diagnosis. The patient had a fall onto his
outstretched arm. He dislocated the left shoulder. He had a 20-25%
inferior glenoid fracture. He also had injury to the labrum and capsule
of that region. He had displacement of the fracture of 3-4 mm. On
exam, he had instability with movement of the arm.

PROCEDURE
Standard posterior portal was created sharply through skin with a scalpel. Blunt trocar
and cannula was placed in the glenohumeral joint. Upon inspection,
there was significant amount of inflammation and synovitis. Also, there
was a significantly large glenoid fracture anteriorly inferiorly. There
was also labral tear anteriorly and some capsular injury. The glenoid
fracture was displaced 3-4 mm. Anterior portal was created through an
outside-in technique. A probe was then placed, and the fracture was
depressed and easily movable. A shaver was placed in the joint, and the
glenoid was debrided for reattachment. I first placed an anchor on the
most inferior aspect of the glenoid with some of the capsule and labral
tissue that had been avulsed. This was placed at approximately the 5
o'clock position. The guide for the anchor was placed on the glenoid,
and then the hole was drilled and then the 3-mm bioabsorbable anchor by
Arthrex was tapped into place. An arthroscopic suture passer was then
placed through the anterior portal through the cannula. Another small
portal was created anterior superiorly. The wire from the suture passer
was taken through here, and then 1 of the suture limbs was taken through
the wire, passing through the capsule labral tissue. This was tied down
with a sliding knot and half hitches. This was repair of the capsule
labral structures, and an anterior capsulorrhaphy was completed. The
sutures were then cut with an arthroscopic suture cutter. Next, I
placed an anchor near the fracture site. I then used a bird beak suture
passer to grab around the fracture, grabbing 1 of the sutures, pulling
this around. I then tied down the suture with a sliding knot and half
hitches. This secured the fragment down nicely. This reduced this
nearly anatomically. This was very secure. The suture limbs were then

cut. Another anchor was put superior to this. There was a labral tear
anteriorly that was secured with this anchor. This was done in a
similar manner. Again, a sliding knot and half hitches were used. This
secured down the labral tear. The suture limbs were then cut. The
probe was then used to probe the capsule, labrum and glenoid fracture.
This was very stable, and there was no movement. There was nearly
anatomic repair of the structures. The remainder of the debris was
irrigated out with a shaver. I then injected Vitagel soft tissue
autograft processed from the patient's blood for postop hemostasis and
potential healing. The instruments were withdrawn. Portals were closed
with suture. Local anesthetic was injected. Sterile dressing was
applied as well as a cold therapy pack over the dressing, and his arm
was placed in an immobilizer. The patient was then awoken from
anesthesia without complication and transferred to post anesthesia care
unit in stable condition.
 
Top