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Thread: Arthroscopy w glenoid fx repair?

  1. #1
    Join Date
    Apr 2007
    Columbus, Ohio

    Red face Arthroscopy w glenoid fx repair?

    AAPC: Back to School
    Good morning Coders, I need your help with this surgery. How would you code the fracture repair? Do I need to use an unlisted code or is it inclusive of one of the other arthroscopic procedures? Thanks in advance for your help. Paula

    1. Left shoulder arthroscopy with fixation of glenoid fracture.
    2. Left shoulder arthroscopy with anterior capsulorrhaphy.
    3. Left shoulder arthroscopy with anterior labral repair.
    4. Left shoulder arthroscopy with extensive debridement of joint.
    5. Vitagel soft tissue autograft insertion, left shoulder wound.

    General with regional block.

    The patient is a 31-year-old male who was seen previously in the office
    with above preop diagnosis. The patient had a fall onto his
    outstretched arm. He dislocated the left shoulder. He had a 20-25%
    inferior glenoid fracture. He also had injury to the labrum and capsule
    of that region. He had displacement of the fracture of 3-4 mm. On
    exam, he had instability with movement of the arm.

    Standard posterior portal was created sharply through skin with a scalpel. Blunt trocar
    and cannula was placed in the glenohumeral joint. Upon inspection,
    there was significant amount of inflammation and synovitis. Also, there
    was a significantly large glenoid fracture anteriorly inferiorly. There
    was also labral tear anteriorly and some capsular injury. The glenoid
    fracture was displaced 3-4 mm. Anterior portal was created through an
    outside-in technique. A probe was then placed, and the fracture was
    depressed and easily movable. A shaver was placed in the joint, and the
    glenoid was debrided for reattachment. I first placed an anchor on the
    most inferior aspect of the glenoid with some of the capsule and labral
    tissue that had been avulsed. This was placed at approximately the 5
    o'clock position. The guide for the anchor was placed on the glenoid,
    and then the hole was drilled and then the 3-mm bioabsorbable anchor by
    Arthrex was tapped into place. An arthroscopic suture passer was then
    placed through the anterior portal through the cannula. Another small
    portal was created anterior superiorly. The wire from the suture passer
    was taken through here, and then 1 of the suture limbs was taken through
    the wire, passing through the capsule labral tissue. This was tied down
    with a sliding knot and half hitches. This was repair of the capsule
    labral structures, and an anterior capsulorrhaphy was completed. The
    sutures were then cut with an arthroscopic suture cutter. Next, I
    placed an anchor near the fracture site. I then used a bird beak suture
    passer to grab around the fracture, grabbing 1 of the sutures, pulling
    this around. I then tied down the suture with a sliding knot and half
    hitches. This secured the fragment down nicely. This reduced this
    nearly anatomically. This was very secure. The suture limbs were then

    cut. Another anchor was put superior to this. There was a labral tear
    anteriorly that was secured with this anchor. This was done in a
    similar manner. Again, a sliding knot and half hitches were used. This
    secured down the labral tear. The suture limbs were then cut. The
    probe was then used to probe the capsule, labrum and glenoid fracture.
    This was very stable, and there was no movement. There was nearly
    anatomic repair of the structures. The remainder of the debris was
    irrigated out with a shaver. I then injected Vitagel soft tissue
    autograft processed from the patient's blood for postop hemostasis and
    potential healing. The instruments were withdrawn. Portals were closed
    with suture. Local anesthetic was injected. Sterile dressing was
    applied as well as a cold therapy pack over the dressing, and his arm
    was placed in an immobilizer. The patient was then awoken from
    anesthesia without complication and transferred to post anesthesia care
    unit in stable condition.

  2. #2
    Join Date
    Apr 2007


    unlisted it is

  3. #3
    Join Date
    Apr 2007
    Columbus, Ohio


    Thanks Mary, that is what I was afraid of..

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