Covert Shoulder Hemiarthroplasty to reverse TSA?

KristinM522

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Can anyone tell me how they would code the procedure below? I don't do many hemi's to TSA's and I can only find advice from prior to the revision TSA codes coming out. I think I am just confusing myself more. Thank you in advance!!

Pre-operative Diagnosis:
Mechanical complication of internal orthopedic graft

After achieving a suitable level of anesthesia using a general anesthetic patient was positioned on the Arthrex positioner so that suitable approach to the left shoulder could be obtained.  Using the prior incision the subcutaneous layers were dissected sharply down to the anterior capsular structures.  Upon entering the capsule cultures were taken we open the capsule to deliver the CTA head and further cultures were taken throughout both tissue and routine cultures for anaerobic and aerobic growth to be held for 10 to 14 days postoperatively.  There was no suspicion of infection from the visual approach at this point in time.  CTA head was removed and the canal was then prepared for a Tornier/right medical reverse stem.  The trial broach was then introduced to protect the proximal humeral structures and the glenoid was then exposed.  Excellent bone structure was remaining here in the glenoid and it was then prepared for the standard baseplate and 2 locking and 1 nonlocking screw along with the central screw was introduced after this was prepped.  A 36 mm offset head was then chosen and the glenosphere was implanted.  Attention was drawn to the humeral side and a standard stem with a 30 mm body and a 6 mm bearing insert was then trialed and reduction revealed excellent range of motion.  The permanent implants were then seated in place.  Prior to doing this multiple sutures and anchors were identified and they were removed in their entirety.  The permanent mint implants were then placed reduction was achieved excellent range of motion stability was achieved at this point in time.  Throughout the case there was copious jet lavage and antibiotic irrigation.  IV antibiotics were started after the last culture was taken.  The wound was then closed with #2 max braid type sutures in the deep layers Vicryl and subcu use Biosyn subcuticular stitch and a Hemovac drain was placed deep in the wound.  Patient tolerated suture well was turned to PAR in stable condition.
 

Orthocoderpgu

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I don't see a prior hemiarthroplasty here. More like an antibiotic spacer was used for infection. What's the graft that was having a problem? I don't see documentation for a graft being removed. Other than checking for signs of infection and taking cultures, a reverse TSA was performed.
 

KristinM522

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Thank you for your response. We didn't do the initial hemiarthroplasty and according to office notes it was done many years ago and we didn't get the old op report prior to this surgery for me to look at. The explant list for this surgery says "humeral head implant". The full dx is actually "Other mechanical complication of other internal orthopedic devices, implants and grafts". I was thinking just a reverse TSA also but I'm not familiar with hemiarthroplasties at all so didn't want to short the MD if there was something else there. Thanks again!
 

Orthocoderpgu

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Thank you for your response. We didn't do the initial hemiarthroplasty and according to office notes it was done many years ago and we didn't get the old op report prior to this surgery for me to look at. The explant list for this surgery says "humeral head implant". The full dx is actually "Other mechanical complication of other internal orthopedic devices, implants and grafts". I was thinking just a reverse TSA also but I'm not familiar with hemiarthroplasties at all so didn't want to short the MD if there was something else there. Thanks again!
There is nothing in that op note that states a humeral head was removed. If the patient had a previous Hemiarthroplasty performed, removing the humeral head implant is not significant work. If your organization has a provider education program this might be a good example to use.
 
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