Sep 18th, 2013 - pinkfirefly7
Can you help? Ortho coding
My doc has coded 23430, 64708, 29826-59,-22; Iam thinking 29822, 29826. Any help will be appreciated.
Under adequate general anesthesia, the patient was placed in the beach chair position and all bony prominences were well padded. His head was secured to the Mayfield headrest and his right shoulder was then examined with the above findings. The right shoulder and arm were then prepped and draped in a sterile fashion. Bony landmarks were marked using a skin marking pencil and portals were marked and infiltrated with 0.25% Marcaine with epinephrine. This same solution was placed in the subacromial space.
The glenohumeral joint was localized via the posterior portal with a spinal needle and was filled with 40 mL of saline solution. The 30-degree arthroscope was then inserted into the glenohumeral joint via the posterior portal. An anterior portal was established using the outside-in technique with a spinal needle, and a working cannula was placed in the joint. A blunt probe was then placed in the joint for tactile examination of the structures therein. The diagnostic arthroscopy was then undertaken with the above findings. The labral tear was debrided back to a stable margin.
The arthroscope was now redirected via the posterior portal in the subacromial space, and the inflow cannula was redirected via the anterior portal in the same space. A midlateral portal was established and a working cannula was placed in the subacromial space. Utilizing an ArthroCare device and a full-radius resector, an extensive bursectomy was performed and scar tissue on the undersurface of the acromion was debrided. Irregularities on the acromion were then noted and attention was turned to the revision acromioplasty. A 5.5 mm bur was inserted through the midlateral portal and the revision acromioplasty was started anteriorly and then laterally. The bur was then placed through the posterior portal with the scope in the midlateral portal, and a cutting block technique was used to finish the acromioplasty.
Attention was now turned towards dissection for the suprascapular nerve. Scar tissue medially inferior to the acromioclavicular joint was debrided. The base of the coracoid was followed up to the coracoclavicular ligament. An auxiliary Neviaser portal was established and a blunt probe was placed through this. Despite dissection in this area, it was difficult to definitively identify the suprascapular nerve.
Attention was now turned to the biceps tenodesis. An axillary skin incision was made measuring approximately 4 cm. This was carried down sharply through the subcutaneous tissues down to the level of the deltopectoral interval. This was incised and the cephalic vein was dissected laterally with the deltoid. Blunt and sharp dissection was carried down to the level of the pectoralis insertion. Deep retractors were inserted. Multiple #2 FiberWire figure-of-eight sutures were placed through the biceps tendon, incorporating it into the falciform ligament of the pectoralis major as well as the transverse humeral ligament. The wound was copiously irrigated. The deltopectoral interval was closed using 2-0 Vicryl figure-of-eight sutures. The skin was closed in two layers using 2-0 Vicryl deep, inverted sutures, followed by running 4-0 Monocryl subcuticular stitch.
The arthroscope was redirected back into the glenohumeral joint via the posterior portal, and the intraarticular portion of the biceps was resected.
Attention was now turned to the suprascapular nerve release. A straight skin incision measuring approximately 4 cm was made in the skin lines between the posterior border of the clavicle and the spine of the scapula. This was made just medial to the coracoid process. This was carried down sharply through subcutaneous tissues down to the level of the trapezial fascia. The trapezius was incised in the direction of its fibers. Blunt dissection was carried down to the anterior table of the scapula. Deep retractors were inserted. The suprascapular nerve was identified. The transverse scapular ligament was isolated utilizing a clamp. This was released sharply. The nerve was bluntly dissected from surrounding scar tissue. The wound was copiously irrigated. The trapezius split was then closed using 2-0 Vicryl figure-of-eight sutures. The skin was closed using 2-0 Vicryl deep, simple inverted sutures, followed by a running 4-0 Monocryl subcuticular stitch. Portals were closed using 4-0 Monocryl subcuticular stitch. Steri-Strips were applied and a dry sterile dressing was placed over this. The patient's arm was placed in a well-padded sling. He was awakened and taken to the recovery room postoperatively in good condition. He tolerated the procedure well. There were no complications. The case was clean