lundi 18 mai 2015

Open Treatment of Lesser Tuberosity Fx?

One of our physicians did a closed reduction of a shoulder dislocation and open treatment of a lesser tuberosity fracture, I am struggling with a code for the fracture treatment. I looked at 23665, closed treatment of shoulder dislocation with fx of greater humeral tuberosity, but that doesn't fit as it was the lesser tuberosity, and there was open treatment. I also looked at 23630 for open greater tuberosity repair but that does not really fit, neither does 23615. I was thinking 23410 because he is re-attaching the subscapularis, but the muscle itself doesn't appear to be torn, or going with unlisted...anyone have any ideas? here is that portion of the op note:

"X-ray fluoroscopy then demonstrated that the humeral head was reduced within the glenoid but there was a significant lesser tuberosity fracture. Therefore I proceeded to the open portion of the case. A deltopectoral approach was utilized, taken down through skin. I identified the cephalic vein and retracted that laterally. The interval between the deltoid and the pectoralis was exposed. Clavipectoral fascia deep to that was then exposed and incised and debrided. Fracture hematoma was identified. The lesser tuberosity fracture fragment was then identified and it was retracted medially. I then brought that into position with the overlying subscapularis. Once exposed I utilized a 5.0 mm titanium Bio corkscrew which obtained good purchase within the underside of the lesser tuberosity. This was pulled in order to ensure that it had appropriate purchase. It was double loaded and the suture limbs were then taken around the lesser tuberosity fracture fragment itself. They were then tied down securely fastening the lesser tuberosity fracture fragment into place."



Open Treatment of Lesser Tuberosity Fx?

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