# Arthroscopic debridement of postoperative hematoma



## Sara82 (Apr 11, 2011)

Not really sure exactly what code I would use for this. If anyone has any suggestions that would be much appriciated. Thanks!

POSTOPERATIVE DIAGNOSIS:
Hematoma, left revision knee replacement.

OPERATION PERFORMED:
Arthroscopic debridement of postoperative hematoma.



DESCRIPTION OF OPERATION:
 Once we had the scope in
the 5.5 radius shaver, all set to go, a stab wound was made in
the superolateral patella portal.  The trocar was entered into
the knee.  We suctioned out as much we could, but of course, it
clotted off quite readily.  The 5.5 shaver was then inserted into
the knee, placed under suction, and staying right beneath the
patella area and the very large open area of the hematoma, we
were able to shave out the hematoma.  We went back and forth
multiple times, re-irrigating the knee, flushing it out
aggressively, manipulating the knee and the soft tissues around
it to free up as much clot as possible.  These were taken out
without much difficulty.  We went back and forth and ended up
running a couple of liters of antibiotic solution through the
knee while simultaneously removing all the clot.  When we flexed
the knee up, we could get it to about 100 degrees.  Some hematoma
was evacuated from the subcutaneous tissue through the staple
line.  By rolling along the staple line, we were able to get this
hematoma out as well.  When all was said and done and multiply
irrigated the knee with antibiotic solution, sucked out all the
clot that was possible, the knee actually looked quite more
normal.  It would basically bend passively to about 100 degrees.
 Happy with this, the portal was closed with 3-0 nylon suture.
 Big bulky dressing was applied as was a little bit of a
compressive Ace bandage.  A tourniquet was deflated.  The patient
was awakened and transferred to recovery room in stable
condition.


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## nyyankees (Apr 12, 2011)

sara82 said:


> not really sure exactly what code i would use for this. If anyone has any suggestions that would be much appriciated. Thanks!
> 
> Postoperative diagnosis:
> Hematoma, left revision knee replacement.
> ...



maybe 29871...


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## maryanneheath (Apr 12, 2011)

I am not sure that I agree with 29871, as there is no infection (unless I totally missed it, which is possible, lol)

You may end up having to go with the unlisted code 29999 and compare to open code 27301, or depending on the insurance carrier, use CPT code 27301 and in box 19 write "performed arthroscopically".


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## Sara82 (Apr 13, 2011)

Thanks for your help. The insurance is Medicare and no, you didnt miss anything there was no infection or concern of infection - Its a tough one. Thanks for both of your inputs and help!


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