I am thinking there should only be one code for this with a modifier for repeat repair but I wanted to get some thoughts just in case. I was thinking a 29827-76 or 29827-52? I was going to use a debridement but it looks like it was only for visualization purposes right? and in order to get to the suture anchor he had to open up the area anyway. Please let me know what you think. I work at an ASC and it's a workmen's comp.
PREOPERATIVE DIAGNOSIS:
Status post left subscapularis repair with disruption of repair and suture anchor pullout.
POSTOPERATIVE DIAGNOSIS:
Status post left subscapularis repair with disruption of repair and suture anchor pullout.
PROCEDURES PERFORMED:
1. Left shoulder arthroscopy with debridement of synovium, subscapularis, and rotator interval.
2. Arthroscopic subscapularis repair.
3. Suture anchor removal.
INDICATIONS:
is a 45-year-old gentleman who underwent a left arthroscopic Bankart repair, biceps tenotomy, and subscapularis repair with the suture anchor two weeks ago. He did well postoperatively but postoperative x?rays showed pullout of the suture anchor from the lesser tuberosity. He is indicated for repeat repair and removal of the anchor.
FINDINGS:
Exam under anesthesia revealed essentially a full range of motion. He had nearly 90 degrees of external rotation with the arm in abduction.
Arthroscopic examination of the glenohumeral joint revealed some residual hemarthrosis. The Bankart repair was intact and stable. The supraspinatus was intact. The subscapularis tear was disrupted. The anchor was seen to be attached to the leading edge of the subscapularis by the two sutures. Probing of the footprint showed the suture anchor track, which was large. It was felt that further suture anchor fixation will be too tenuous and the soft tissue repair would need to be done instead of a suture anchor repair to bone. The subacromial space was unremarkable.
PROCEDURE IN DETAIL:
Following induction of general anesthesia, the patient was placed in the lateral decubitus position with the left shoulder up. The left shoulder and upper extremity were prepped and draped in the usual fashion and suspended from 8-pound longitudinal traction.
Standard posterior, anterosuperior, and anteroinferior portals were established and diagnostic arthroscopy was performed with the findings as above. A shaver was used to remove hemorrhage and debris. The fibrinous tissue over the subscapularis was débrided as was the interval tissue in the synovium to adequately visualize. The leading edge of the subscapularis was identified with the attached suture anchor. A working cannula was placed anteroinferiorly. The sutures were cut with the scissors and the anchor was retrieved. There was good stout interval tissue at the leading edge of the supraspinatus including superior glenohumeral ligament and some interval scar tissue. It was felt that the subscapularis should be repaired to best to avoid having to put another suture anchor in the tenuous lesser tuberosity bone. Lassos were used to place two simple sutures from the superior leading edge of the subscapularis into the stout interval tissue at the leading edge of the supraspinatus. These sutures were tied and provided a good solid repair, which did reconstitute the role the superior edge of the subscapularis and restored tension in the subscapularis.
The arthroscope was withdrawn. The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the subacromial space. A sterile dressing was applied followed by a sling. The patient was awakened and extubated in the operating room and transferred to the recovery
THANKS AGAIN!
Susan
PREOPERATIVE DIAGNOSIS:
Status post left subscapularis repair with disruption of repair and suture anchor pullout.
POSTOPERATIVE DIAGNOSIS:
Status post left subscapularis repair with disruption of repair and suture anchor pullout.
PROCEDURES PERFORMED:
1. Left shoulder arthroscopy with debridement of synovium, subscapularis, and rotator interval.
2. Arthroscopic subscapularis repair.
3. Suture anchor removal.
INDICATIONS:
is a 45-year-old gentleman who underwent a left arthroscopic Bankart repair, biceps tenotomy, and subscapularis repair with the suture anchor two weeks ago. He did well postoperatively but postoperative x?rays showed pullout of the suture anchor from the lesser tuberosity. He is indicated for repeat repair and removal of the anchor.
FINDINGS:
Exam under anesthesia revealed essentially a full range of motion. He had nearly 90 degrees of external rotation with the arm in abduction.
Arthroscopic examination of the glenohumeral joint revealed some residual hemarthrosis. The Bankart repair was intact and stable. The supraspinatus was intact. The subscapularis tear was disrupted. The anchor was seen to be attached to the leading edge of the subscapularis by the two sutures. Probing of the footprint showed the suture anchor track, which was large. It was felt that further suture anchor fixation will be too tenuous and the soft tissue repair would need to be done instead of a suture anchor repair to bone. The subacromial space was unremarkable.
PROCEDURE IN DETAIL:
Following induction of general anesthesia, the patient was placed in the lateral decubitus position with the left shoulder up. The left shoulder and upper extremity were prepped and draped in the usual fashion and suspended from 8-pound longitudinal traction.
Standard posterior, anterosuperior, and anteroinferior portals were established and diagnostic arthroscopy was performed with the findings as above. A shaver was used to remove hemorrhage and debris. The fibrinous tissue over the subscapularis was débrided as was the interval tissue in the synovium to adequately visualize. The leading edge of the subscapularis was identified with the attached suture anchor. A working cannula was placed anteroinferiorly. The sutures were cut with the scissors and the anchor was retrieved. There was good stout interval tissue at the leading edge of the supraspinatus including superior glenohumeral ligament and some interval scar tissue. It was felt that the subscapularis should be repaired to best to avoid having to put another suture anchor in the tenuous lesser tuberosity bone. Lassos were used to place two simple sutures from the superior leading edge of the subscapularis into the stout interval tissue at the leading edge of the supraspinatus. These sutures were tied and provided a good solid repair, which did reconstitute the role the superior edge of the subscapularis and restored tension in the subscapularis.
The arthroscope was withdrawn. The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the subacromial space. A sterile dressing was applied followed by a sling. The patient was awakened and extubated in the operating room and transferred to the recovery
THANKS AGAIN!
Susan