BFAITHFUL
Expert
Dr. did a partial thickness supraspinatus tendon tear repair with subacromial decompression, & resection of 8mm of lateral aspect of the clavicle on 11/12/09
I'm leaning towards 726.2, 715.31, 726.10
23412, (23130??) & 23120
I know 23130 is bundled according to CCI but according to AAOS it's not , & this is a non medicare patient.
DX: Posttraumatic impingement syndrome, Degenerative arthritis of AC joint, status post grade 1 AC separation of right shoulder, partial thickness tear of supraspinatus tendon.
patient's has a work related injury occured on 6/24 and after an extensive course of physical therapy and corticosteriod subacromial injections and acromioclavicular injections & after failing an extensive course of rehabilitation which included antiinflammatories and injection, patient is now indicated for operative intervention.
Operative Note:
The proposed incision site ablated with the acromion and extending obliquely across was marked and the whole surgical site was infiltrated with 1% lidocaine with epinephrine to minimize the blood loss. A #10 blade was used to resect down to the through the underlying subcutaneous tissue using Bovie elctrocautery used throughout the case for hemostasis. Upon obtaining the clavipectoral fascia, the skin edges were undermined to createe a mobile window. A deltoid on approach was used with the Bovie electrocautery to elevate the deltoid tendon off of the acromion on to the lateral aspect of the clavicle and a full thickness subperiosteal fashion. After the acromion was exposed, coracoacromial ligament was resected and Darrach retractor was inserted beneath the acromion and the anterior aspect of the acromion was resected with the oscillating saw. This was followed by resection of the undersurface of the acromion also the oscillating saw followed by use of oscillating foot rasp to smooth all the rough edges down. Great care was taken to standard the resection and burring of the undersurface of the acromion extending to the most lateral aspect of the acromion. The acromioclavicular joint was inspected. There was noted to be significant spurring of the joint with marked thickening of the soft tissues surrounding this consistent with his previous injury. After the lateral aspect of the clavicle was exposed. Holman retractors were inserted anteriorly and posteriorly and the lateral aspect of the acromion was resected with the oscillating saw used followed by the use of the oscillating foot rasp to ascertain there were no rough edges the undersurface also burred to remove any spurs that were present at the lateral aspect of the clavicle. The area was copiously irrigated significant thickened hypertrophic bursal tissue was noted over the supraspinatus tendon. This was carefully excised. The tendon was insepcted and at the order the acromion there was noted to be area of partial thickness tear consistent with the impingement of the acromion in that area. This was not noted to be full thicknessa nd this was carefully debrided and the edges were re-approximated using #2 fiberwire interrupted figure of eight sutures. The remainder of the cuff was inspected. A digital lysis of adhesions was performed circumferentially and the remainder of the rotator cuff was found to be intact.
I'm leaning towards 726.2, 715.31, 726.10
23412, (23130??) & 23120
I know 23130 is bundled according to CCI but according to AAOS it's not , & this is a non medicare patient.
DX: Posttraumatic impingement syndrome, Degenerative arthritis of AC joint, status post grade 1 AC separation of right shoulder, partial thickness tear of supraspinatus tendon.
patient's has a work related injury occured on 6/24 and after an extensive course of physical therapy and corticosteriod subacromial injections and acromioclavicular injections & after failing an extensive course of rehabilitation which included antiinflammatories and injection, patient is now indicated for operative intervention.
Operative Note:
The proposed incision site ablated with the acromion and extending obliquely across was marked and the whole surgical site was infiltrated with 1% lidocaine with epinephrine to minimize the blood loss. A #10 blade was used to resect down to the through the underlying subcutaneous tissue using Bovie elctrocautery used throughout the case for hemostasis. Upon obtaining the clavipectoral fascia, the skin edges were undermined to createe a mobile window. A deltoid on approach was used with the Bovie electrocautery to elevate the deltoid tendon off of the acromion on to the lateral aspect of the clavicle and a full thickness subperiosteal fashion. After the acromion was exposed, coracoacromial ligament was resected and Darrach retractor was inserted beneath the acromion and the anterior aspect of the acromion was resected with the oscillating saw. This was followed by resection of the undersurface of the acromion also the oscillating saw followed by use of oscillating foot rasp to smooth all the rough edges down. Great care was taken to standard the resection and burring of the undersurface of the acromion extending to the most lateral aspect of the acromion. The acromioclavicular joint was inspected. There was noted to be significant spurring of the joint with marked thickening of the soft tissues surrounding this consistent with his previous injury. After the lateral aspect of the clavicle was exposed. Holman retractors were inserted anteriorly and posteriorly and the lateral aspect of the acromion was resected with the oscillating saw used followed by the use of the oscillating foot rasp to ascertain there were no rough edges the undersurface also burred to remove any spurs that were present at the lateral aspect of the clavicle. The area was copiously irrigated significant thickened hypertrophic bursal tissue was noted over the supraspinatus tendon. This was carefully excised. The tendon was insepcted and at the order the acromion there was noted to be area of partial thickness tear consistent with the impingement of the acromion in that area. This was not noted to be full thicknessa nd this was carefully debrided and the edges were re-approximated using #2 fiberwire interrupted figure of eight sutures. The remainder of the cuff was inspected. A digital lysis of adhesions was performed circumferentially and the remainder of the rotator cuff was found to be intact.
