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Thread: coracoclavicular ligament reconstruction w allograft

  1. #1
    Join Date
    Apr 2007
    Columbus, Ohio

    Question coracoclavicular ligament reconstruction w allograft

    AAPC: Back to School
    Good morning coders, I need your help with this shoulder surgery. So far I have 23552 and 29826 coded but not sure if the ligament surgery is bundled with the primary procedure or has it's own code. I really need some guidance on this one. Thanks in advance for your help, Paula

    1. Open reconstruction of acromioclavicular joint with allograft.
    2. Left shoulder arthroscopy with coracoclavicular ligament
    reconstruction with allograft and Arthrex TightRope.
    3. Left shoulder scope with subacromial decompression.

    A standard posterior portal was created sharply
    through the skin with a scalpel. Blunt trocar and camera was placed
    into the glenohumeral joint posteriorly. Upon initial inspection the
    biceps tendon was intact. Labrum was intact circumferentially. The
    articular cartilage was without any lesions. The glenohumeral pouch was
    without any loose bodies. Rotator cuff was intact anterior-posterior.
    Subscapularis was intact anteriorly. The glenohumeral joint was normal.
    The camera was withdrawn. Subacromial space was entered posteriorly. A
    separate lateral incision was made with a scalpel through the skin.
    Blunt trocar was placed into the subacromial space. There was a
    significant amount of inflammation and bursitis. A shaver was placed
    the lateral portal and bursectomy was completed. A thermal wand by
    ArthroCare was then taken to release the soft tissue on the undersurface
    of the acromion as well as release the coracoacromial ligament
    anterolaterally. This revealed a spur on the acromion. This was
    removed with the bur. The decompression was completed. Remainder of
    the bursa was cleared out with a shaver. The rotator cuff was inspected
    and there were no tears. Next the coracoid was identified. The scope
    was placed on the lateral portal. A separate anterior portal was
    created. This was made over the coracoid process. Thermal wand was
    then used to debride the coracoid process space for exposure both top
    and bottom. Once this was completed, I withdrew the instruments. I
    made a vertical incision over the clavicle 3.5 cm medial to the distal
    aspect. This was made with a scalpel. Blunt dissection was taken down
    to the deep fascia. Skin was undermined with tenotomy scissors. Blunt
    retractor was placed in the wound. All hemostasis obtained throughout
    the case with Bovie. The deep fascia was split in line with clavicle
    with Bovie. This revealed the clavicle. Again 3.5 cm medial to the
    distal end of the clavicle in the center of the clavicle the guide pin
    was placed. A 6-mm drill was then used over the pin drilling a hole in
    the clavicle. Once this was completed, I placed a scope in the lateral
    portal again. I placed the guide by Arthrex through the anterior portal
    and also the arm was superiorly in the hole just previously drilled.
    distal end of the clavicle in the center of the clavicle the guide pin
    was placed.
    The clavicle was reduced. The pin was placed through the hole onto the
    clavicle base superiorly. I drilled the pin into the guide in the
    center of the clavicle in the center of the coracoid base. The 6-mm
    reamer was taken then through the clavicle and through the coracoid.
    The guide was removed as well as the guide pin. Nitinol wire was placed
    through the drill bit which was grabbed with a grasper through the
    anterior portal in the inferior aspect of the coracoid process. The
    core reamer was removed. I did have a posterior tibial tendon allograft
    to reconstruct the coracoacromial ligament. This had to be cut down to
    a 5 mm graft. This was looped on itself. A #2-FiberWire was taken to
    whip stitch both ends. This measured 5 mm through the measuring device.
    The center of the graft was then tied on the end of the button by
    Arthrex. This was a TightRope Endobutton by Arthrex that was utilized.

    The end of the graft was pulled up through the button proximally. The
    white suture was taken through the top of the nitinol wire and loaded,
    pulling this through the clavicle through the coracoid base out
    anteriorly. The inferior button was taken and pulled through the
    clavicle and the coracoid base. This was viewed under the scope. I had
    to maneuver the button on the inferior aspect of the coracoid. This
    engaged nicely. The clavicle was reduced manually and I could see the
    AC joint reduced anatomically. The button was tensioned with the suture
    and then tied down. The graft was then tensioned as well. Nitinol wire
    was placed between the graft and a 5.5 bioabsorbable anchor by Arthrex
    was then placed between the graft in the button securing this into
    place. Once this was fully seated, the two ends of the graft were taken
    over the AC joint. I took a hemostat through the old AC ligament and
    fascia out the lateral side pulling this through the tissue,
    reconstructing the acromioclavicular ligament superiorly and
    posteriorly. The graft was tied on itself and then with the graft
    looped on itself and tied with a #2-FiberWire. Now the ends of the
    graft were cut. The clavicle was released and this appeared to be
    anatomic. The scope was placed back in the subacromial space. I could
    see the clavicle well reduced. Remainder of the subacromial space was
    irrigated out with saline and debris was removed with a shaver. The
    instruments were withdrawn. The deep fascia was closed with #1 Vicryl.
    Vita-Gel soft tissue autograft was injected deeply. Skin was
    approximated with 2-0 Vicryl and a running 4-0 Prolene was placed
    intradermally. Steri-Strips and Mastisol were applied. Portals were
    closed with suture. Local anesthetic was injected. Sterile dressing
    was applied. The patient's arm was placed in an immobilizer. The
    patient was then awoken from anesthesia without complication and
    transferred to the postanesthesia care in stable condition.

  2. #2
    Join Date
    Apr 2007


    its going to be unlisted Paula

  3. #3
    Join Date
    Apr 2007
    Columbus, Ohio


    Thanks Mary, so it would be the unlisted 29999 for arthroscopy? Do you have an open procedure that it would be comparable to? Would it be similiar to 23415? Thanks for your help, Paula

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