Wiki Debridement CPT -Shldr - infection

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RebeccaMoney

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I need help determining which CPT is more appropriate 23030 or 11044. My physician is doing a revision of a reverse total shoulder arthroplasty (23473). He also did an excisional debridement of fascia, abscess cavity, bone, muscle, devitalized tissue from the infection. Can 23030 be used for "debridement" even though it is an irrigation and drainage or would 11044 be the better code since it is a debridement?
Any thoughts? Thank you,
 
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I'm also looking at 23035. The op report reads "The abscess cavity did communicate down to the prosthesis and additionally distally within the anterior arm. I thoroughly evacuated this. I removed the polyethylene. I performed a through debridement of fascia, abscess cavity, bone, muscle, devitalized tissue from the infection. This was done with a rongeur and knife. I removed as much of the involved tissue as possible around the glenoid and humeral implant. I then irrigated the wound with 3 liters of normal saline.
 
not 23035 antibiotic irrigation wasn't done. I am leaning towards 23030

23030-23031

The physician drains a deep abscess or hematoma in 23030 or an infected bursa in 23031 from the shoulder area. The physician makes an incision in the shoulder overlying the site of the abscess, hematoma, or bursa to be incised. Dissection is carried down through the deep subcutaneous tissues and may be continued into the fascia or muscle to expose the abscess or hematoma. The incision may be extended if the mass is larger than expected. When the infected bursa, abscess, or hematoma is identified, it is incised and the contents are drained. The area is irrigated and the incision is repaired in layers with sutures, staples, and/or Steri-strips; closed with drains in place; or simply left open to further facilitate drainage of infection.
as this a true replacement of both components of shoulder?
 
my question at end should've been at top of note
Was this a true replacement of both components? or was it just removed for the purpose of abscess and put back?
 
nickelclaw said:
my question at end should've been at top of note
Was this a true replacement of both components? or was it just removed for the purpose of abscess and put back?
Click to expand...
Patient developed shoulder pain about a week ago. An aspiraton was done which was consistent with purulence. A cell count was performed which demonstrated eleveated white blood cell count consistent with periprosthetic infection. So, yes, I believe it was removed and polyethylene exchanged due to infection.
 
I would need to see the op note or more information to help you. But...
A poly liner exchange and washout of the TSA (glenohumeral) for infection is 23040. It's not just 23030 because it requires an arthrotomy. 23030 is only incision and drainage deep but not into the joint.

You would go into the TSA revision codes 23473 or 23474 when either the humeral or glenoid components, or both are removed and replaced in the same operative session.
11044 is not correct for poly liner exchange & washout of a prosthesis.

Also to your statement, "My physician is doing a revision of a reverse total shoulder arthroplasty (23473). He also did an excisional debridement of fascia, abscess cavity, bone, muscle, devitalized tissue from the infection." You would not report any of the debridement work, washout, etc. if he truly was doing 23473 because all of that would be included in 23473. 23473 includes arthrotomy, synovectomy, osteotomy and the removal of the components in place, among other things.

If we start talking about staged treatment of infection of a prosthesis in the hip/knee/shoulder, then we start getting into different codes and possible drug delivery device codes too.

I think I have suggested to you prior that the AAOS Complete Global Service Data for Ortho would really help you and/or possibly taking an AAOS/Zupko ortho course :)
I am pretty sure there are CPT Assistant articles that address this liner exchange question and other prosthesis questions. If you have a CPT Professional or Expert book under the codes it directs you to the month/year of the CPT Assistant.
 
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