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Attempted Open Repair from an Arthroscopic Procedure..

  1. Default Attempted Open Repair from an Arthroscopic Procedure..
    Medical Coding Books
    Need help with how to code for an "attempted" open repiar with an arthroscopic procedure.

    SURGICAL PROCEDURE:
    Right shoulder arthroscopy, arthroscopic debridement of the stump
    of the subscapularis, debridement of a partial thickness
    supraspinatus tear. Arthroscopic subacromial decompression, an
    acromioplasty as well as an open attempted repair of the
    subscapularis tear.

    A 4 mm posterior portal was made and the scope
    was placed in the joint without difficulty. Using a spinal
    needle, an anterior working portal was created. It was quite
    evident he had completely retracted subscapularis tear with the
    stump of the subscapularis on the lesser tuberosity. I debrided
    the end of the tendon that was just hanging in the joint. I then
    proceeded with debridement of partial thickness supraspinatus
    tear. The biceps looked actually very good. It was not
    unstable. It was really not inflamed. He did have some mild
    inflammation of the joint itself but the cartilage looked good.
    I then went to the subacromial space, performed a complete
    subacromial decompression and acromioplasty. He did have
    extensive bursitis with impingement for which I performed an
    arthroscopic acromioplasty, as well. I then placed the scope
    laterally and came anteriorly through the portal. I certainly
    could see the rest of the subscapularis which was adhesed. I
    actually placed a traction stitch in it and tried to release the
    adhesions. I was very cognizant of the coracoid, visualized the
    whole coracoid and this was outlined as very carefully
    neurovascular structures of course. I released even the
    coracoacromial ligament region as well as anything adhesed around
    the subscapularis tendon, and it was not coming back. I did want
    to make every attempt possible to repair it. It was certainly
    not coming back arthroscopically. I did make an anterior
    incision, incised through the anterior raphe of the deltoid, was
    very careful with the nerve inferiorly to minimize the split of
    course and then I identified the tendon. I then tried to perform
    a release very carefully even on the articular side and despite
    doing this, I could get the tendon back halfway to the lesser
    tuberosity. So there was unfortunately, despite various
    different things to mobilize the tendon and putting traction
    stitches in it, it just would not come back. Therefore, this was
    abandoned.

    Any help is greatly appriciated. Thank you!

  2. #2
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    Long Island/New York
    Posts
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    Default
    Quote Originally Posted by Sara82 View Post
    Need help with how to code for an "attempted" open repiar with an arthroscopic procedure.

    SURGICAL PROCEDURE:
    Right shoulder arthroscopy, arthroscopic debridement of the stump
    of the subscapularis, debridement of a partial thickness
    supraspinatus tear. Arthroscopic subacromial decompression, an
    acromioplasty as well as an open attempted repair of the
    subscapularis tear.

    A 4 mm posterior portal was made and the scope
    was placed in the joint without difficulty. Using a spinal
    needle, an anterior working portal was created. It was quite
    evident he had completely retracted subscapularis tear with the
    stump of the subscapularis on the lesser tuberosity. I debrided
    the end of the tendon that was just hanging in the joint. I then
    proceeded with debridement of partial thickness supraspinatus
    tear. The biceps looked actually very good. It was not
    unstable. It was really not inflamed. He did have some mild
    inflammation of the joint itself but the cartilage looked good.
    I then went to the subacromial space, performed a complete
    subacromial decompression and acromioplasty. He did have
    extensive bursitis with impingement for which I performed an
    arthroscopic acromioplasty, as well. I then placed the scope
    laterally and came anteriorly through the portal. I certainly
    could see the rest of the subscapularis which was adhesed. I
    actually placed a traction stitch in it and tried to release the
    adhesions. I was very cognizant of the coracoid, visualized the
    whole coracoid and this was outlined as very carefully
    neurovascular structures of course. I released even the
    coracoacromial ligament region as well as anything adhesed around
    the subscapularis tendon, and it was not coming back. I did want
    to make every attempt possible to repair it. It was certainly
    not coming back arthroscopically. I did make an anterior
    incision, incised through the anterior raphe of the deltoid, was
    very careful with the nerve inferiorly to minimize the split of
    course and then I identified the tendon. I then tried to perform
    a release very carefully even on the articular side and despite
    doing this, I could get the tendon back halfway to the lesser
    tuberosity. So there was unfortunately, despite various
    different things to mobilize the tendon and putting traction
    stitches in it, it just would not come back. Therefore, this was
    abandoned.

    Any help is greatly appriciated. Thank you!
    What i see is 23412-53 (53 mod for discontinued procedure) and 29826-59 for acrimioplasty thru scope.

  3. Default
    That makes sense, thank you so much for your help!

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