joanne71178
Guru
I am confused on how to code this Shoulder surgery. Would I use 23332-22 or 23332 & 23470 (for the re-insertion of the humeral head)? Would the debridement of scar tissue be bundled with 23332?
"With the patient in the beach chair postion, her previous deltopectoral incision was used and carried down to the deltopectoral interval. The deltopectoral interval was dissected out. The cephalic vein was not encountered in the area of scar tissue. The patient had significant scarring and her preoperative should motion included flexion to 20 degrees and abduction to 20 degrees, external rotation to 20 degrees, internal rotation to L5. The patient appeared to have good preop deltoid function.
The dissection was carried out lateralto the coracoid process and the subscapularis tendon was dissected off the proximal humerus. There was an area of layered scar tiddue which appeared to be bursal with no healthy supraspinatus tendon. The scar tissue was sesected and the proximal humerus was dislocated superiorly. The humeral head was removed from the prosthesis and the axillary nerve was identified at the inferior aspect of the glenoid. Capsular release was performed. Pan capsular release was performed with Mayo scissors at the edge of the glenoid and, after satisfactory debridement of the , the glenoid retactors were inserted. The Biomet comprehensive fracture and reverse arthroplasty instruments were used. A3/2 guide wire was inserted through the drill guide into the center of the glenoid at the inferior aspect of the glenoid.
The palpation of the anterior neck of the gelnoid was consistent with slight retroversion of the glenoid and the guide pin was placed parallel with the neck
Due to remaining tightness of the soft tissue , the soft tissue on the medial proximal humerus was carefully dissected out avoiding the axillary nerve and the ***uda retractor was used to retract the humeral head posteriorly, inferiorly. While using the initial reamer the glenoid fractured with compromise of approximately a third of the glenoid primarily inferiorly and posteriorly. The glenoid was assessed for insertion of reversed arthroplasty or attempt at inserting a standard prosthesis. It was due tot he compromise of the glenoid. It was felt that allowing healing to occur prior to re-attempt at achieving glenoid and placing a glenoid implant would be preferable.
The humeral head was re-inserted. Mobility was much improved and due to resection of scar tissue which included a portion of the rotator cuff, the rotator cuff was not re-repaired. There was noted to be a fracture of the coracoid process approximately 15mm from the tip which was left in situ. The small Hemovac drain was inserted.................."
"With the patient in the beach chair postion, her previous deltopectoral incision was used and carried down to the deltopectoral interval. The deltopectoral interval was dissected out. The cephalic vein was not encountered in the area of scar tissue. The patient had significant scarring and her preoperative should motion included flexion to 20 degrees and abduction to 20 degrees, external rotation to 20 degrees, internal rotation to L5. The patient appeared to have good preop deltoid function.
The dissection was carried out lateralto the coracoid process and the subscapularis tendon was dissected off the proximal humerus. There was an area of layered scar tiddue which appeared to be bursal with no healthy supraspinatus tendon. The scar tissue was sesected and the proximal humerus was dislocated superiorly. The humeral head was removed from the prosthesis and the axillary nerve was identified at the inferior aspect of the glenoid. Capsular release was performed. Pan capsular release was performed with Mayo scissors at the edge of the glenoid and, after satisfactory debridement of the , the glenoid retactors were inserted. The Biomet comprehensive fracture and reverse arthroplasty instruments were used. A3/2 guide wire was inserted through the drill guide into the center of the glenoid at the inferior aspect of the glenoid.
The palpation of the anterior neck of the gelnoid was consistent with slight retroversion of the glenoid and the guide pin was placed parallel with the neck
Due to remaining tightness of the soft tissue , the soft tissue on the medial proximal humerus was carefully dissected out avoiding the axillary nerve and the ***uda retractor was used to retract the humeral head posteriorly, inferiorly. While using the initial reamer the glenoid fractured with compromise of approximately a third of the glenoid primarily inferiorly and posteriorly. The glenoid was assessed for insertion of reversed arthroplasty or attempt at inserting a standard prosthesis. It was due tot he compromise of the glenoid. It was felt that allowing healing to occur prior to re-attempt at achieving glenoid and placing a glenoid implant would be preferable.
The humeral head was re-inserted. Mobility was much improved and due to resection of scar tissue which included a portion of the rotator cuff, the rotator cuff was not re-repaired. There was noted to be a fracture of the coracoid process approximately 15mm from the tip which was left in situ. The small Hemovac drain was inserted.................."