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excision calcium deposit in the sternal pectoralis tendon

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    Default excision calcium deposit in the sternal pectoralis tendon
    Medical Coding Books
    Please help


    I'm not sure what code to use for the excision of calcium deposit in the sternal head pectoralis tendon. For the rcr-23412 29826 and 29824.


    DESCRIPTION OF PROCEDURE AND FINDINGS: The patient was brought into the operating room in supine position. Anesthesia was introduced. The shoulder was prepped and draped in usual sterile manner for surgery with the patient in the sitting position for arthroscopy. A posterior portal was made 1 cm medial and inferior to the posterior angle of the acromion after prepping and draping. The scope was non-traumatically introduced into the glenohumeral joint and the anterior portal was made meeting with the AC joint above the level of the coracoid was directed through the rotator interval. A shaver was placed in. Some incidental trimming was performed. Scope was placed in the subacromial space. A lateral portal was made even with the anterior third of the acromion. A shaver was placed in. A bursectomy was performed. Coracoacromial ligament was released from the anterior aspect of the acromion. A section was removed and the anterior undersurface of the acromion was removed in fashion so it was even with the posterior undersurface of the acromion. The anterior edge was posterior to the anterior cortex of the clavicle. The scope was placed in the lateral portal, burr in the posterior portal. Subacromial decompression was planed, smooth, and flat. Then, the AC joint was débrided of soft tissue and the distal clavicle excision was performed for a distance of 12 to 14 mm preserving the posterior and superior acromioclavicular joint ligaments and trapezial fascia. Then, the cuff tear was identified. It was rather complex tear and anterior incision was made about 4 cm long in Langer line from anterior of the acromion to a point superolateral to the coracoid. Dissection was carried sharply through the subcutaneous tissue. Skin flaps were elevated. The deltoid was split in line with its fibers beginning near the anterior aspect of the acromioclavicular joint extending to a point 3.5 cm distal to the anterior acromion. A stay suture was placed at this level to prevent propagation split. The deltoid was split. A section of the coracoacromial ligament was removed. The bursectomy was completed. The edges of the cuff tear were excised sharply so we had good bleeding tissue with smooth edges. Two #2 FiberWire were passed intra-articularly through the bone and then using the combination of tendon to tendon #2 FiberWire and tendon to bone vertical mattress suture the cuff was quite securely repaired back to the cuff and bone of the shoulder and it was a nice repair. This was good and stable. Then, we placed some link type retractors under the deltoid. First we looked with the arthroscope and went down to the long head of the biceps and really could not see anything as far as calcium deposit or mass so then we looked down under direct visualization. The biceps tendon looked fine. I then with my finger palpated the deep surface of the pectoralis insertion and I could feel the calcium deposit. It would be really impossible to get through, through the superior incision, so a small anterior axillary incision was made. We discussed making another little incision if needed and deltopectoral interval was developed. The cephalic vein was taken laterally. The deltoid was retracted laterally and we were able to lift off the clavicular head quite easily without detaching it and then it was hard to get to the back side of the sternal head and the calcium deposit was actually in the tendon, so we made an incision longitudinally in the tendon about 2 cm long into the calcium deposit and used a curette to remove it and then also where it was down a little farther, we really did not want to make another incision longitudinally in the tendon and we did needle it with the spinal needle along the calcium deposit in order to try to get it to release. The wounds were irrigated. The sternal head of the pectoralis tendon was longitudinal split and it was repaired with interrupted 0 Vicryl suture.
    Thanks for your help!!!
    Last edited by coder067; 06-22-2010 at 05:40 AM.

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