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shoulder chondroplasty with abrasion-plasty

  1. #1
    Location
    Columbus, Ohio
    Posts
    105
    Post shoulder chondroplasty with abrasion-plasty
    Medical Coding Books
    Hello coders, I have attached op notes for a arthroscopic shoulder surgery. I have codes for everything except the chrondroplasty with abrasion-plasty of the glenoid. I'm thinking it might be inclusive to one of the other procedures but could use some help. I have coded this:
    29827
    29807
    29826
    29824
    29823

    Any suggestions? Thanks again, Paula


    PROCEDURE
    1. Left shoulder arthroscopy with rotator cuff repair.
    2. Left shoulder arthroscopy with labral repair.
    3. Left shoulder arthroscopy with subacromial decompression through
    separate fascial plane.
    4. Left shoulder arthroscopy with distal clavicle excision through
    separate fascial plane.
    5. Left shoulder arthroscopy with chondroplasty with abrasion-plasty
    of the glenoid.
    6. Left shoulder arthroscopy with extensive debridement of joint.

    DESCRIPTION OF PROCEDURE
    Patient seen in preop holding by department of orthopedics and
    anesthesia, at which time she identified the left upper extremity as the
    appropriate extremity for the procedure. I placed my initials on the
    extremity for identification. She was given IV antibiotics
    preoperatively for prophylaxis. Taken back to the OR suite and placed
    supine on a well-padded table. She is administered regional block by
    anesthesia for postop pain relief. She is then placed under general
    anesthesia without complication. She was then placed in a beach-chair
    position again with all bony processes well-padded. Left upper
    extremity was sterilely prepped and draped in normal fashion. A
    standard posterior portal was made through the skin with a scalpel.
    Blunt trocar and cannulas placed in the glenohumeral joint posteriorly.
    There is some fraying of the glenoid, and there was a large articular
    cartilage lesion with a flap tear of the anteroinferior glenoid. A
    separate anterior portal was created using an outside-in technique
    through the interval. A probe was placed, and there was a 1-cm flap
    cartilage lesion of the anteroinferior glenoid. Chondroplasty was
    completed on this to a stable border. This was done to bare bone.
    There was also some labral tearing around this area. The rotator cuff
    appeared to be intact, anterior to posterior. There was some labral
    fraying around the removed glenoid with remainder of the glenoid intact.
    The shaver was placed in the joint, and the joint was extensively
    debrided. Since the patient did have a labral tear around the area of
    cartilage injury, I was going to advance the labrum over the cartilage
    injury to help this heal in. I placed 1 cannula in the anterior portal.
    I placed a guide for the Arthrex anchor in the defect and then drilled
    and placed in a 3.5 bioabsorbable anchor. This was tapped into place.
    A suture passer was taken around the glenoid inferiorly, and one of the
    suture limbs was passed through the labrum. Sliding knot half-hitches
    were used to tie down the labrum into the cartilage defect. This
    covered over nicely. The suture limbs were cut with an arthroscopic
    cutter. The humeral head did not have any significant articular
    cartilage lesions. There are no loose bodies in the axillary pouch.
    The biceps labral complex was intact superiorly. Once this was
    completed, the instruments were withdrawn. Subacromial space was
    entered posteriorly with the scope. A separate lateral incision was
    made, and a shaver was placed in the subacromial space. There was a
    significant amount of inflammation and bursitis. This was removed with
    a shaver. Thermal wand by ArthroCare was then taken through the lateral
    portal, and the soft tissue on the undersurface of the acromion was
    released as well as the coracoacromial ligament anterolaterally. This
    revealed a large spur. A bur was taken to remove the spur. The
    decompression was completed. The AC joint could now be seen, and this
    is severely arthritic with inferior spurring causing impingement. A
    separate fascial plane through the anterior portal was created and a bur
    was used to resect 1 cm of distal clavicle. Care was taken to preserve
    the capsule ligamentous structures superiorly and posteriorly. Once
    this was completed, the rotator cuff was inspected. There was a 90%
    bursal-sided tear approximately 1 cm of the supraspinatus but more
    posteriorly. This was debrided and completed. The insertion was
    separate fascial plane through the anterior portal was created and a bur
    was used to resect 1 cm of distal clavicle. Care was taken to preserve
    the capsule ligamentous structures superiorly and posteriorly. Once
    this was completed, the rotator cuff was inspected. There was a 90%
    bursal-sided tear approximately 1 cm of the supraspinatus but more
    posteriorly. This was debrided and completed. The insertion was
    prepared with the bur. A separate posterolateral incision was made off
    the acromion, and a punch was placed in the insertion where the rotator
    cuff was torn. The punch was used, and then a 5.5 fully-threaded
    Corkscrew anchor by Arthrex was screwed into place. The suture limbs
    were passed through the cuff with a Scorpion suture passer in a simple
    manner. The arm was abducted and sutures were tied down with a sliding
    knot and half-hitches. The suture was then cut. This was an excellent
    repair of the rotator cuff back to its insertion. This was probed and
    felt to be very stable. The remainder of the subacromial space was
    irrigated out with a shaver. The instruments were withdrawn, and
    portals were closed with suture. Local anesthetic was injected. A
    sterile dressing was applied as well as a cold therapy pack over the
    gown. The patient's arm was placed in an immobilizer. The patient then
    awoken from anesthesia without complication and transferred to the post
    anesthesia care unit in stable condition.

  2. #2
    Default
    the chrondroplasty is going to be included in the 29823 and dont for get to bill for the screws that were used

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    I agree, it bundles with the 29823.

    Trose....Paula codes for a physician (not an ASC) therefore she is unable to capture the coding for the screws.

    Mary

  4. #4
    Location
    Columbus, Ohio
    Posts
    105
    Smile shoulder surgery
    Thanks for all your help, Paula

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