tbensonite
Guest
Ok, I'm starting to pull my hair out. Hopefully somebody can shed light on this.
Diagnosis- Rt shoulder displaced 4-part proximal humerus fracture.
Surgical Procedure- Rt shoulder hemiarthroplasty AND internal fixation of a displaced greater and lesser tuberosities.
Can these two procedures be billed together??
Surgical Procedure Description(Short version):
..a deltopectoral approach was used to the shoulder with sharp dissection through the subcutaneous tissues and hemostatsis obtained using electrocautery. Blunt dissection through the interval where the cephalic vein was present was then done to expose the underlying rotator cuff area. There was noted to be obvious displacement of the greater tuberosity. The lesser tuberosity was also retracted medially with the humeral head impacted and rotated substantially. The humeral head was then able to be extracted. The long head of biceps tendon was actually noted to be absent. The other smaller bony fragments were also then removed. At this point, the humeral shaft was approached using hand-held reamer. these were done up to a size 13. A 13 mm stem was then placed and with the head and reduced. Satisfactory position and stability with soft tissue tension was identified. A cement restrictor was placed into the humeral shaft and then the 13 mm stem was cemented into place. A #2 Orthocord and FiberWire were used around through the holes in the proximal stem. At this point, the humeral head was impacted into place. The shoulder was reduced and then the #2 Orthocord and FiberWire were passed sequentially through the greater and lesser tuberosities with drill holes as required until these were passed. Then, the sutures were tied to reapproximate the bony fragments. Satisfactory stability was identified. Wound irrigated and closed...
So, is the internal fixation procedure included in the hemiarthroplasty?
Any direction would be greatly appreciated.
Diagnosis- Rt shoulder displaced 4-part proximal humerus fracture.
Surgical Procedure- Rt shoulder hemiarthroplasty AND internal fixation of a displaced greater and lesser tuberosities.
Can these two procedures be billed together??
Surgical Procedure Description(Short version):
..a deltopectoral approach was used to the shoulder with sharp dissection through the subcutaneous tissues and hemostatsis obtained using electrocautery. Blunt dissection through the interval where the cephalic vein was present was then done to expose the underlying rotator cuff area. There was noted to be obvious displacement of the greater tuberosity. The lesser tuberosity was also retracted medially with the humeral head impacted and rotated substantially. The humeral head was then able to be extracted. The long head of biceps tendon was actually noted to be absent. The other smaller bony fragments were also then removed. At this point, the humeral shaft was approached using hand-held reamer. these were done up to a size 13. A 13 mm stem was then placed and with the head and reduced. Satisfactory position and stability with soft tissue tension was identified. A cement restrictor was placed into the humeral shaft and then the 13 mm stem was cemented into place. A #2 Orthocord and FiberWire were used around through the holes in the proximal stem. At this point, the humeral head was impacted into place. The shoulder was reduced and then the #2 Orthocord and FiberWire were passed sequentially through the greater and lesser tuberosities with drill holes as required until these were passed. Then, the sutures were tied to reapproximate the bony fragments. Satisfactory stability was identified. Wound irrigated and closed...
So, is the internal fixation procedure included in the hemiarthroplasty?
Any direction would be greatly appreciated.
