Need some help with the following:
Doc wants to bill just 23130 & 23120......but Im thinking 23412, no 23130(bundled) and no 23120 bcuz no size of distal clavicle resection is mentioned
DX: right shoulder impingement syndrome (726.2), degenerative arthritis of AC (715.31)
Procedure: Subacromial decompression & bursctomy of right shoulder, lateral clavicle resection. & repair of partial thickness tear of the supraspinatus tendon
26 year old female with impingement syndrome of the right shoulder. The patient had failed to improve despite the use of antiinflammatories, corticosteriod injection, and extensive course of physical therapyl She did have an MRI which revealed evidence of impingement syndrome and synovitis of the AC joint. the patient after failing to show improvement with conservative management was indicated for surgery.
The proposed incision site over the anterior aspect of the acromion and clavicle was marked out and injected with 1% lidocaine with epinephrine. A linear incision was centered over this anterior and lateral aspect of the acromion and brought medially. A bovie electrocautery was used throughout the case for hemostasis. Upon obtaining the clavipectoral fascia, the plane was developed to create a mobile window and the Bovie electrocautery was used to perform deltoid on full thickness ablation of the deltoid tendon off of the acromion and the lateral clavicle. The anterior aspect of the acromion was noted to have a type II acromion and a Darrach retractor was inserted undersurface the coracoacromial ligament resection. The anterior aspect of the acromion was then resected with the oscillating saw and a darrach retractor was then further inserted under the acromion and the undersurface of the acromion was resected with the oscillating saw. Followed by use of the oscillating foot rasp to smooth the roughened edges down great care was taken to ascertain that the resection and dcompression then performed to the lateral most aspect of the acromion. The lateral clavicle was inspected and there was noted to be hypertrophic spurring along the inferior aspect and this was debrided with the oscillating foot rasp followed by resection of the lateral aspect of the clavicle with the oscillating saw followed by use of the oscillating foot rasp. At this point, a bursectomy was performed. There was notd to be over the supraspinatus tendon at the anterior aspect of the acromion and partial thickness tear of the superior surface of the supraspinatus tendon. This was not a full thickness tear. A 2-0 PDS suture was used in a figure of eight fashion to reapproximate this defect. The remainder of the cuff was inspected and found to be intact. The subscapularis and infraspinatus tendons were all noted to be intact and a glove finger was inserted and no further adhesions were appreciated.