Wiki Open Rotator Cuff Debridement

[SJSCHMIDT91]

I have a case that an avulsed rotator cuff was treated by open debridement rather than repaired due to it being 'not repairable' any ideas?
-I'm not sure it would be appropriate to code a tenotomy being that it is avulsed, so its really not being released.
-repair seems out of the question
-29822 or 29823 seem appropriate, however this was done OPEN

please help!
**also I already know code for acromioplasty, only concerned with open debridement code. i'll deal with the cci's later**

The glenohumeral joint was injected with 50 mL of saline and then the
arthroscope was introduced posteriorly. There was found to be a massive
tear in the rotator cuff tendon with the edge of the tendon being just
lateral to the glenoid. On the MRI, it appeared there may be loose bodies
inferiorly, but none were found. There was only significant synovitis.
Her biceps tendon was intact. The arthroscope was then removed and an
incision was made at the anterolateral corner of the acromion. This was
taken through the skin and subcutaneous tissue sharply and electrocautery
was used for hemostasis. The deltoid was split between the anterior and
middle thirds and elevated off the anterior aspect of the acromion. The
acromion was exposed and then an acromioplasty was performed using a
micro-oscillating saw, removing the anterior-inferior 5 mm of the acromion.
This provided ample room in the subacromial space. Then, the rotator cuff
was evaluated. The biceps tendon was still intact, but the supraspinatus
tendon and infraspinatus tendon were completely avulsed and retracted back
almost to the glenoid. Subscapularis tendon was intact. Blunt dissection
was used to try and mobilize the supraspinatus tendon. I was able to
mobilize it about a centimeter, but this still only got close to the center
of the humeral head. I was not able to get it anywhere near the insertion
site. There was also significant fraying of the tendon and the quality of
it was quite poor. Therefore, I elected to just debride the frayed
fibrinous portion of the supraspinatus and infraspinatus tendons as the
tear was not repairable. After this debridement was completed, the wound
was irrigated and then the fluid removed with suction.

Thank you!

 

[SJSCHMIDT91]

got help on this from my supervisor and one of our doc's. if anyone else runs into this problem here is what we found (the rational is in the plain English or lay description)
23107

Description of Procedure

Clinical Synopsis

Using an anterior approach, a skin incision is made over the deltoid and pectoral muscles. The muscles are divided and the scapularis tendon is split to expose the glenohumeral joint capsule. The joint capsule is incised and the joint is explored. The joint is flushed with normal saline to remove any debris. The humeral head and glenoid fossa are examined for osteochondral defects. Any fraying or instability of the anterior and posterior labrum is evaluated. The anterior joint capsule and subscapularis and glenohumeral ligaments are examined for tears, adhesions, or fraying. The biceps tendon is examined for tears, inflammation, or degenerative disease. Any tearing of the rotator cuff is evaluated. The supraspinatus and infraspinatus tendons are examined as is the subacromial space. The posterior aspect of the glenohumeral joint is then examined including the axillary pouch and posterior recess. Any loose or foreign bodies within the glenohumeral joint are located and removed. The joint is again flushed with normal saline. Following completion of the procedure, the incisions are closed, and a dressing is applied.