Lisa A
Networker
Please help me with CPT codes. I am struggling to code the following:
PROCEDURE:
Right shoulder arthroscopy and d bridement with anterior reconstruction
utilizing the Arthrex system utilizing FiberWire suture and three anchors as
well as subacromial bursectomy and subacromial decompression.
DETAILS OF PROCEDURE:
...The usual camera and instrumentation portals were
made posteriorly, laterally, and two anterior portals one superior and one
inferior for the anterior reconstruction. The glenohumeral joint was first
inspected. The patient was noted to have anterior and inferior instability
with subluxation of the humeral head inferiorly as well as anteriorly.
The patient was noted to have degenerative tear of the posterior inferior
labrum. This was d brided. The anterior labrum was noted to be quite
hemorrhagic with evidence of partial tearing. After evaluation of the
articular surface in the labrum, the rotator cuff was inspected. This was
noted to be intact. Bicipital tendon was noted to be intact. At this point,
it was determined that the patient's primary symptomatology secondary to the
anterior and inferior instability required anterior reconstruction through the
anterior portals. Utilizing elevator, the anterior and inferior labrum was
elevated from the anterior glenoid from the 1 o'clock position just anterior to
the bicipital origin down to the 5:30 position. After elevation of the labrum,
the anterior glenoid was then rasped and abraded. When this was complete,
three FiberWire sutures were placed in the usual manner inferior, inferior
middle, and middle portions of the capsule and labrum.
After placement of the FiberWire sutures the drill was then utilized to make
the appropriate drill holes in the anterior glenoid one at approximately the
4:30 position, one at the 3 o'clock position, and one at approximately the 1:30
position. The capsule and labrum was then advanced and the Arthrex anchors
were then seated into the drill holes beginning from inferior to superior.
After placement of the anchors, excellent fixation was obtained and excellent
stability was noted of the glenohumeral joint with external rotation to
approximately 30O. When this was complete, the glenohumeral joint was
profusely irrigated. All loose bodies were removed. The repair was then again
inspected and excellent stability was noted.
At this point, the glenohumeral joint was drained. The subacromial space was
then entered through the posterior portal with a camera and then through the
lateral portal. Bursectomy was performed and soft tissues were removed from the
undersurface of the anterior two-thirds of the acromion. After adequate
visualization had been obtained aggressive acromioplasty was performed.
Bursectomy was then completed and the subacromial space was then profusely
irrigated and drained. Portal sites were approximated utilizing 4-0 nylon
interrupted manner. Sterile dressings were applied as was a shoulder
immobilizer. The patient was awakened and transferred to the PAR in stable
condition.
PROCEDURE:
Right shoulder arthroscopy and d bridement with anterior reconstruction
utilizing the Arthrex system utilizing FiberWire suture and three anchors as
well as subacromial bursectomy and subacromial decompression.
DETAILS OF PROCEDURE:
...The usual camera and instrumentation portals were
made posteriorly, laterally, and two anterior portals one superior and one
inferior for the anterior reconstruction. The glenohumeral joint was first
inspected. The patient was noted to have anterior and inferior instability
with subluxation of the humeral head inferiorly as well as anteriorly.
The patient was noted to have degenerative tear of the posterior inferior
labrum. This was d brided. The anterior labrum was noted to be quite
hemorrhagic with evidence of partial tearing. After evaluation of the
articular surface in the labrum, the rotator cuff was inspected. This was
noted to be intact. Bicipital tendon was noted to be intact. At this point,
it was determined that the patient's primary symptomatology secondary to the
anterior and inferior instability required anterior reconstruction through the
anterior portals. Utilizing elevator, the anterior and inferior labrum was
elevated from the anterior glenoid from the 1 o'clock position just anterior to
the bicipital origin down to the 5:30 position. After elevation of the labrum,
the anterior glenoid was then rasped and abraded. When this was complete,
three FiberWire sutures were placed in the usual manner inferior, inferior
middle, and middle portions of the capsule and labrum.
After placement of the FiberWire sutures the drill was then utilized to make
the appropriate drill holes in the anterior glenoid one at approximately the
4:30 position, one at the 3 o'clock position, and one at approximately the 1:30
position. The capsule and labrum was then advanced and the Arthrex anchors
were then seated into the drill holes beginning from inferior to superior.
After placement of the anchors, excellent fixation was obtained and excellent
stability was noted of the glenohumeral joint with external rotation to
approximately 30O. When this was complete, the glenohumeral joint was
profusely irrigated. All loose bodies were removed. The repair was then again
inspected and excellent stability was noted.
At this point, the glenohumeral joint was drained. The subacromial space was
then entered through the posterior portal with a camera and then through the
lateral portal. Bursectomy was performed and soft tissues were removed from the
undersurface of the anterior two-thirds of the acromion. After adequate
visualization had been obtained aggressive acromioplasty was performed.
Bursectomy was then completed and the subacromial space was then profusely
irrigated and drained. Portal sites were approximated utilizing 4-0 nylon
interrupted manner. Sterile dressings were applied as was a shoulder
immobilizer. The patient was awakened and transferred to the PAR in stable
condition.