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Shoulder surgery question??

  1. Question Shoulder surgery question??
    Medical Coding Books
    Does anyone know what code to use for open acromiale fixation w/screws would be?
    Op note says:
    incision was made at the edge of the acromion starting above at the level of the corticoid and going back to the posterior aspect of the acromion. The skin flaps were raised and hemostasis obtained w/ bovie electrocautery. The unstable os acromiale was found with an 18-guage spinal needle and the fascia overlying the acromion split with a bovie in lined with the deltoid fibers. The deltoid was slightly split to facilitate palpation under the acromion. Gelpi retractors were placed. The acromion was then debrided fibrous tissue at the gap there. The bone was fairly smooth, so this was curetted and rongeur used to debride the edges at least superiorly. This bone was then saved and used to pack it later. A smooth k wire was then utilized to stimulate bleeding on both sides creating a flat raw surface that would abut. A trial reduction was then obtained and 3 k wires were inserted, 2 of these were threaded k wires, started from anterior to posterior. These were positioned. They were roughly in the mid point of the acromion. A great care was taken to ensure that it did not violate the inferior surface where the cuff was. These were then exited out back of the shoulder and with digital palpation foun to be of appropriate length. They were then measured and a 4.0 cannulated screw was placed over each one of these. Digital palpation again was utilized to confirm that there was no violation of the subacromial space. Large fluoroscopy was utilized to check placement at least in the anterior and posterior plane since the lateral or an outlet view was not posssible on the table. A third front back screw was then placed slightly more laterally to try to ensure adequate fixation due to his large size. All 3 screws had good purchase. Fluoroscopic films confirmed that they were all securely within bone.
    Any suggestions were be appreciated.
    Thank you,

  2. #2
    What is the DX for this procedure?

  3. Default
    I'm not even sure about the DX it says Symptomatic os acromiale. This is not a fracture.

  4. #4
    The doctor states in the op report that "a trial reduction was obtained". Sounds like a dislocation or fracture and perhaps a non-union or chronic condition. I would send a query to the doctor and clarify the DX before trying to settle on a procedure.

  5. Default
    Dx's 726.10, 726.91. Still not sure on the procedure. The only code i'm thinking is 23130.

  6. Default
    I just spoke with the doctor and he said the acromion is loose and needed to be repaired and he said it is almost like an ORIF. And so he doesnt think 23130 will work.

  7. #7
    Did a bit of research and os acromiale is the DX. Os acromiale results from failure of an anterior acromial ossification center to fuse with the acromial process. I'd find out if this is an acute injury, a chronic condition resulting from an acute injury or a congenital condition. I did not find a satisfactory procedure code--this may end up being an unlisted code. Anyone else?

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