Attempted Open Repair from an Arthroscopic Procedure..

Sara82

Guru
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Need help with how to code for an "attempted" open repiar with an arthroscopic procedure.

SURGICAL PROCEDURE:
Right shoulder arthroscopy, arthroscopic debridement of the stump
of the subscapularis, debridement of a partial thickness
supraspinatus tear. Arthroscopic subacromial decompression, an
acromioplasty as well as an open attempted repair of the
subscapularis tear.

A 4 mm posterior portal was made and the scope
was placed in the joint without difficulty. Using a spinal
needle, an anterior working portal was created. It was quite
evident he had completely retracted subscapularis tear with the
stump of the subscapularis on the lesser tuberosity. I debrided
the end of the tendon that was just hanging in the joint. I then
proceeded with debridement of partial thickness supraspinatus
tear. The biceps looked actually very good. It was not
unstable. It was really not inflamed. He did have some mild
inflammation of the joint itself but the cartilage looked good.
I then went to the subacromial space, performed a complete
subacromial decompression and acromioplasty. He did have
extensive bursitis with impingement for which I performed an
arthroscopic acromioplasty, as well. I then placed the scope
laterally and came anteriorly through the portal. I certainly
could see the rest of the subscapularis which was adhesed. I
actually placed a traction stitch in it and tried to release the
adhesions. I was very cognizant of the coracoid, visualized the
whole coracoid and this was outlined as very carefully
neurovascular structures of course. I released even the
coracoacromial ligament region as well as anything adhesed around
the subscapularis tendon, and it was not coming back. I did want
to make every attempt possible to repair it. It was certainly
not coming back arthroscopically. I did make an anterior
incision, incised through the anterior raphe of the deltoid, was
very careful with the nerve inferiorly to minimize the split of
course and then I identified the tendon. I then tried to perform
a release very carefully even on the articular side and despite
doing this, I could get the tendon back halfway to the lesser
tuberosity. So there was unfortunately, despite various
different things to mobilize the tendon and putting traction
stitches in it, it just would not come back. Therefore, this was
abandoned.

Any help is greatly appriciated. Thank you!
 

nyyankees

True Blue
Messages
1,272
Location
Long Island/New York
Best answers
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Need help with how to code for an "attempted" open repiar with an arthroscopic procedure.

SURGICAL PROCEDURE:
Right shoulder arthroscopy, arthroscopic debridement of the stump
of the subscapularis, debridement of a partial thickness
supraspinatus tear. Arthroscopic subacromial decompression, an
acromioplasty as well as an open attempted repair of the
subscapularis tear.

A 4 mm posterior portal was made and the scope
was placed in the joint without difficulty. Using a spinal
needle, an anterior working portal was created. It was quite
evident he had completely retracted subscapularis tear with the
stump of the subscapularis on the lesser tuberosity. I debrided
the end of the tendon that was just hanging in the joint. I then
proceeded with debridement of partial thickness supraspinatus
tear. The biceps looked actually very good. It was not
unstable. It was really not inflamed. He did have some mild
inflammation of the joint itself but the cartilage looked good.
I then went to the subacromial space, performed a complete
subacromial decompression and acromioplasty. He did have
extensive bursitis with impingement for which I performed an
arthroscopic acromioplasty, as well. I then placed the scope
laterally and came anteriorly through the portal. I certainly
could see the rest of the subscapularis which was adhesed. I
actually placed a traction stitch in it and tried to release the
adhesions. I was very cognizant of the coracoid, visualized the
whole coracoid and this was outlined as very carefully
neurovascular structures of course. I released even the
coracoacromial ligament region as well as anything adhesed around
the subscapularis tendon, and it was not coming back. I did want
to make every attempt possible to repair it. It was certainly
not coming back arthroscopically. I did make an anterior
incision, incised through the anterior raphe of the deltoid, was
very careful with the nerve inferiorly to minimize the split of
course and then I identified the tendon. I then tried to perform
a release very carefully even on the articular side and despite
doing this, I could get the tendon back halfway to the lesser
tuberosity. So there was unfortunately, despite various
different things to mobilize the tendon and putting traction
stitches in it, it just would not come back. Therefore, this was
abandoned.

Any help is greatly appriciated. Thank you!
What i see is 23412-53 (53 mod for discontinued procedure) and 29826-59 for acrimioplasty thru scope.
 
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