kmuth
Contributor
How would you code this since there is no conversion shoulder cpt? Since it has been years since her hemi would you code a total shoulder or revision? I included a note from the last office visit plus the op note.
This is from the office visit -This is a DePuy hemi. We talked about possible surgery. This would be a revision to reverse total shoulder replacement. We would need the DePuy reverse total shoulder system. We would need possible implant extraction set. Goals, risks and benefits were described in detail, including the recovery.
Op Note
PREOPERATIVE DIAGNOSIS: failed right shoulder hemiarthroplasty for fracture (glenoid based pain)
PROCEDURES PERFORMED: 1. Revision right reverse total shoulder arthroplasty. 2. Explantation of hardware, humeral head, proximal humeral body components
ANESTHESIA: General plus block. ESTIMATED BLOOD LOSS:250mL. COMPLICATIONS: None. DISPOSITION: Recovery room in stable condition.
IMPLANTS: Depuy Baseplate, std Glenosphere: 38 std Epiphysis: right, size 1 Insert: 38+9 Culture X1-- humeral head membrane
Findings: Distal stem well fixed
INDICATIONS: This is a 69-year-old female with right shoulder pain and limited function and motion secondary to above diagnosis They have failed conservative treatment and after a discussion of risks, benefits, and alternatives, wished to proceed with shoulder arthroplasty.
DESCRIPTION OF PROCEDURE: On the day of surgery, the patient identified the right shoulder as the correct operative extremity. This was initialed by the surgeon with the patients's acknowledgment. The patient underwent placement of an interscalene block and was taken to the operating room and placed in the supine position. Upon induction of adequate anesthesia, the patient was brought up to the beach chair position and the shoulder and upper extremity were prepped and draped in the usual sterile fashion. Timeout confirmed the correct patient and operative extremity as well as that antibiotics were on board. A standard deltopectoral approach to the shoulder was carried out. It was carried sharply through the skin and subcutaneous tissue. Medial and lateral flaps were developed over the deltopectoral fascia. The cephalic vein was identified and mobilized laterally with the deltoid. The subdeltoid and subpectoral spaces were mobilized and a blunt retractor was placed deep to this. The clavipectoral fascia was opened on the lateral edge of the conjoined tendon and the retractor was moved deep to this. . A subscapularis tenotomy of the remnant subscapularis was performed and rotator interval was released to the glenoid exposing the humeral head. The inferior capsule was released directly off the humerus to allow greater than 90° of external rotation. The humeral head and proximal body was extracted without difficulty and the head adapter removed without difficulty. Culture specimen was handed off. The glenoid exposed. T A centering hole was drilled . A baseplate was prepped and placed and screws placed The glenosphere was then inserted . The humerus was carefully subluxed back anteriorly. A proximal body, epiphysis trial was placed A liner tray and polyethylene were placed and trialing was carried out. The appropriate final sizes were chosen and locked into place. The shoulder was then reduced. This allowed nearly full passive range of motion with no instability. The joint was copiously irrigated with orthopedic irrigation after the final implants were assembled and locked into place. vancomycin powder was placed in the wound
This is from the office visit -This is a DePuy hemi. We talked about possible surgery. This would be a revision to reverse total shoulder replacement. We would need the DePuy reverse total shoulder system. We would need possible implant extraction set. Goals, risks and benefits were described in detail, including the recovery.
Op Note
PREOPERATIVE DIAGNOSIS: failed right shoulder hemiarthroplasty for fracture (glenoid based pain)
PROCEDURES PERFORMED: 1. Revision right reverse total shoulder arthroplasty. 2. Explantation of hardware, humeral head, proximal humeral body components
ANESTHESIA: General plus block. ESTIMATED BLOOD LOSS:250mL. COMPLICATIONS: None. DISPOSITION: Recovery room in stable condition.
IMPLANTS: Depuy Baseplate, std Glenosphere: 38 std Epiphysis: right, size 1 Insert: 38+9 Culture X1-- humeral head membrane
Findings: Distal stem well fixed
INDICATIONS: This is a 69-year-old female with right shoulder pain and limited function and motion secondary to above diagnosis They have failed conservative treatment and after a discussion of risks, benefits, and alternatives, wished to proceed with shoulder arthroplasty.
DESCRIPTION OF PROCEDURE: On the day of surgery, the patient identified the right shoulder as the correct operative extremity. This was initialed by the surgeon with the patients's acknowledgment. The patient underwent placement of an interscalene block and was taken to the operating room and placed in the supine position. Upon induction of adequate anesthesia, the patient was brought up to the beach chair position and the shoulder and upper extremity were prepped and draped in the usual sterile fashion. Timeout confirmed the correct patient and operative extremity as well as that antibiotics were on board. A standard deltopectoral approach to the shoulder was carried out. It was carried sharply through the skin and subcutaneous tissue. Medial and lateral flaps were developed over the deltopectoral fascia. The cephalic vein was identified and mobilized laterally with the deltoid. The subdeltoid and subpectoral spaces were mobilized and a blunt retractor was placed deep to this. The clavipectoral fascia was opened on the lateral edge of the conjoined tendon and the retractor was moved deep to this. . A subscapularis tenotomy of the remnant subscapularis was performed and rotator interval was released to the glenoid exposing the humeral head. The inferior capsule was released directly off the humerus to allow greater than 90° of external rotation. The humeral head and proximal body was extracted without difficulty and the head adapter removed without difficulty. Culture specimen was handed off. The glenoid exposed. T A centering hole was drilled . A baseplate was prepped and placed and screws placed The glenosphere was then inserted . The humerus was carefully subluxed back anteriorly. A proximal body, epiphysis trial was placed A liner tray and polyethylene were placed and trialing was carried out. The appropriate final sizes were chosen and locked into place. The shoulder was then reduced. This allowed nearly full passive range of motion with no instability. The joint was copiously irrigated with orthopedic irrigation after the final implants were assembled and locked into place. vancomycin powder was placed in the wound