jhaleycoder
Networker
Hi Everyone--
I coded the OP note below as 23472 and 23405. UHC is stating that the CPT codes billed are incorrect. I feel like I am going crazy with UHC. Am I missing something? If someone could quickly review. We have have appealed twice.
Procedure:
1. Right reverse total shoulder arthroplasty
2. Biceps tenotomy
Implants:
1. Zimmer mini small augmented baseplate with 36 mm standard glenosphere, 6.5 x 25 mm central screw
2. Zimmer 7x83 identity humeral stem with 36 -6 tray, standard polyethylene liner
EBL: 150 mL
Complications: None
Indications: This is a 78-year-old female who presents with chronic right shoulder pain and severe glenohumeral osteoarthritis. After failing conservative measures we discussed a right reverse total shoulder replacement. We discussed the risks and benefits of surgery with major risks including: infection, nerve injury, blood vessel injury, continued pain, instability, tendon failure, acromial stress fracture, periprosthetic fracture, and implant failure. She elected to proceed.
Procedure in detail: The patient was identified in the pre-operative holding area. Surgical site was marked. She was brought to the operating room and transferred to the bed in a beach-chair position. General Anesthesia was induced. 2g Ancef was administered as well as 1 g of TXA. The right arm was prepped and draped in sterile usual fashion. Deltopectoral approach was utilized. Cephalic vein was retracted lateral and protected throughout the case. The subscapularis tendon was intact. The biceps tendon was identified and a tenotomy was performed. A subscapularis peel was performed along with the capsule from the surgical neck of the humerus with bovie electrocautery exposing the humeral head allowing it to completely dislocate anteriorly. The subscapularis tendon as well as capsule was tagged. The majority of the rotator cuff remained intact throughout the case and was not released. There was extensive medial osteophytes which were excised utilizing a osteotome and rongeur. Using the humeral head cutting guide set for 30 degrees of retroversion the head was resected with a saw. The cut was excellent. The humeral head was retracted and the glenoid was exposed with a series of cobra and blunt Homan retractors. Glenoid exposure was excellent. The remaining biceps and labrum was debrided from the glenoid edge 360 degrees. Anterior and inferior capsule deep to the subscapularis was released along with the rotator interval. Using pre-operative software and printed 3d guide the central pin as well as augmented pin was placed. Articular cartilage was removed with Cobb elevator. Glenoid was reamed to the predetermined depth utilizing the 3D printed guide. As planned a small augmented baseplate was chosen with the augment placed posterosuperiorly. This was planned utilizing the preoperative software. The small augmented baseplate was impacted with excellent contact to native. Central screw was drilled for and measured. This also achieved excellent fixation. 3 peripheral locking screws were drilled for, measured and placed. The 36 mm standard glenosphere was chosen with 1.5 mm inferior offset and subsequently impacted into place. Excellent fixation was confirmed. The humeral head was then dislocated back anteriorly. The canal finder was placed and by hand the canal reamed up to 8 mm which had a solid fit and subsequently broached to a size 7. The inset reamer was also utilized appropriately. No evidence of humeral canal perforation. Prior to stem placement x3 drill holes were placed utilizing a 2-0 drill bit within the bicipital groove and x3 nonabsorbable sutures were passed. The final size 7 stem was impacted into place. It had excellent press-fit fixation. Trial neutral polyethylene was placed and shoulder reduced. This reduction was more appropriate and there was evidence of full passive ROM achieved with no evidence of significant impingement until extremes of motion. The humeral head was dislocated anteriorly and trial poly removed. The -6 inset humeral tray and standard polyethylene were also impacted into place. Excellent fixation was achieved. The joint was irrigated with diluted saline and irrisept. Components were reduced and again excellent stability mirroring the trial. 1g of Vancomycin was placed deep as well as superficial to deltopectoral interval. x3 nonabsorbable were passed individually in mason-allen fashion within the subscapularis tendon. Approximation of the tendon was achieved without significant tension. The deltopectoral interval was closed with running #1 stratafix, subcutaneous tissue with 3-0 stratafix and skin was 3-0 Monocryl. Steri strips were placed. A PICO incisional wound vac was placed as well and confirmed to be on good suction without leaks.
I coded the OP note below as 23472 and 23405. UHC is stating that the CPT codes billed are incorrect. I feel like I am going crazy with UHC. Am I missing something? If someone could quickly review. We have have appealed twice.
Procedure:
1. Right reverse total shoulder arthroplasty
2. Biceps tenotomy
Implants:
1. Zimmer mini small augmented baseplate with 36 mm standard glenosphere, 6.5 x 25 mm central screw
2. Zimmer 7x83 identity humeral stem with 36 -6 tray, standard polyethylene liner
EBL: 150 mL
Complications: None
Indications: This is a 78-year-old female who presents with chronic right shoulder pain and severe glenohumeral osteoarthritis. After failing conservative measures we discussed a right reverse total shoulder replacement. We discussed the risks and benefits of surgery with major risks including: infection, nerve injury, blood vessel injury, continued pain, instability, tendon failure, acromial stress fracture, periprosthetic fracture, and implant failure. She elected to proceed.
Procedure in detail: The patient was identified in the pre-operative holding area. Surgical site was marked. She was brought to the operating room and transferred to the bed in a beach-chair position. General Anesthesia was induced. 2g Ancef was administered as well as 1 g of TXA. The right arm was prepped and draped in sterile usual fashion. Deltopectoral approach was utilized. Cephalic vein was retracted lateral and protected throughout the case. The subscapularis tendon was intact. The biceps tendon was identified and a tenotomy was performed. A subscapularis peel was performed along with the capsule from the surgical neck of the humerus with bovie electrocautery exposing the humeral head allowing it to completely dislocate anteriorly. The subscapularis tendon as well as capsule was tagged. The majority of the rotator cuff remained intact throughout the case and was not released. There was extensive medial osteophytes which were excised utilizing a osteotome and rongeur. Using the humeral head cutting guide set for 30 degrees of retroversion the head was resected with a saw. The cut was excellent. The humeral head was retracted and the glenoid was exposed with a series of cobra and blunt Homan retractors. Glenoid exposure was excellent. The remaining biceps and labrum was debrided from the glenoid edge 360 degrees. Anterior and inferior capsule deep to the subscapularis was released along with the rotator interval. Using pre-operative software and printed 3d guide the central pin as well as augmented pin was placed. Articular cartilage was removed with Cobb elevator. Glenoid was reamed to the predetermined depth utilizing the 3D printed guide. As planned a small augmented baseplate was chosen with the augment placed posterosuperiorly. This was planned utilizing the preoperative software. The small augmented baseplate was impacted with excellent contact to native. Central screw was drilled for and measured. This also achieved excellent fixation. 3 peripheral locking screws were drilled for, measured and placed. The 36 mm standard glenosphere was chosen with 1.5 mm inferior offset and subsequently impacted into place. Excellent fixation was confirmed. The humeral head was then dislocated back anteriorly. The canal finder was placed and by hand the canal reamed up to 8 mm which had a solid fit and subsequently broached to a size 7. The inset reamer was also utilized appropriately. No evidence of humeral canal perforation. Prior to stem placement x3 drill holes were placed utilizing a 2-0 drill bit within the bicipital groove and x3 nonabsorbable sutures were passed. The final size 7 stem was impacted into place. It had excellent press-fit fixation. Trial neutral polyethylene was placed and shoulder reduced. This reduction was more appropriate and there was evidence of full passive ROM achieved with no evidence of significant impingement until extremes of motion. The humeral head was dislocated anteriorly and trial poly removed. The -6 inset humeral tray and standard polyethylene were also impacted into place. Excellent fixation was achieved. The joint was irrigated with diluted saline and irrisept. Components were reduced and again excellent stability mirroring the trial. 1g of Vancomycin was placed deep as well as superficial to deltopectoral interval. x3 nonabsorbable were passed individually in mason-allen fashion within the subscapularis tendon. Approximation of the tendon was achieved without significant tension. The deltopectoral interval was closed with running #1 stratafix, subcutaneous tissue with 3-0 stratafix and skin was 3-0 Monocryl. Steri strips were placed. A PICO incisional wound vac was placed as well and confirmed to be on good suction without leaks.