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Thread: Disarticulation, left shoulder

  1. #1

    Default Disarticulation, left shoulder

    AAPC: Back to School
    Hello, all. I actually work for a general surgeon so I am not entirely familiar with these types of surgeries. I had this coded, but then another coder informed me that she felt this was a different code. I'm hoping for some input.

    The patient was taken to the operating room after induction of adequate general anesthesia. He was prepped and draped in the usual sterile fashion and placed at a 45 degree angle in a \"Farm's\" chair. The skin was marked for the planned incision to involve the anterior and posterior skin flaps. The patient had multiple previous scars from surgeries involving and tendon transfer, subclavian and brachioplexus repairs. The incisions were modified to incorporate these incisions. The fish mouth incision was then made with the #10 blade carried down through the subcutaneous tissue. Cautery was utilized to develop the incision anteriorly. The anterior musculature including the pectoralis major and the coracobrachialis was then detached from their insertion points. The axillary vasculature was then identified. The axillary vein was noted and encircled and ligated with 2-0 silk suture. The nerves were identified and also divided. The attention was then turned towards the humerus where the insertion points of the biceps and triceps were identified, as well as, Terry's minor. There were carefully detached from the humerus. The posterior insertions were also developed. The periosteal elevator was utilized and the humeral shaft was exposed circumferentially. Once this was completed and the medial vasculature had been divided, the tissue of the biceps and triceps were divided with cautery. With the soft tissue completely divided, the bone was carefully dissected free from the surrounding tissue to the level of the rotator cuff. The rotator cuff was opened and careful to maintain adequate tissue to ultimately close it over the glenoid fossa. The humerus was completely removed and the upper extremity passed off to specimen. Hemostasis was achieved with electrocautery. The rotator cuff was then closed over the glenoid fossa and followed by the musculature of the serratus anterior and biceps. The skin flaps were trimmed appropriately and the deep tissue was reapproximated with interrupted 0 and 2-0 Vicryl. Clips were applied to the skin. A 10 mm Jackson-Pratt drain was then placed. A pressure dressing was applied. The estimated blood loss was, perhaps, 500 mL. The patient was taken to the recovery room in stable condition.

  2. #2
    Join Date
    Apr 2007
    Greater Pittsburgh


    Look @ 23920.
    Last edited by jdemar; 08-03-2011 at 12:15 PM.
    jdemar, CPC, CMA

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