# Difficult Open & Arthroscopic Knee case



## joanne71178 (Jul 16, 2013)

"The patient is a 14 year old male who sustained a bicycle related injury one day ago, landing onto his left knee.  He presented to the emergency room, had a deep medial side laceration to his knee.  The emergency room performed a Methylene Blue dye test with an injection into the left knee, did not appear to communicate with the laceration.  He was irrigated in the emergency room and repair of the laceration was performed.  He was seen in the office today, had significant amount of effusion and pain with range of motion of his knee.  There was some contamination of the laceration site, with erythema." 

The patient was taken to the OR......

"The sutures on the medial side of the incision were removed.  The wound was evaluated and there was noted to be some contamination into the wound.  The wound was thoroughly irrigated with pulse lavage.  *There was a partial thickness tear of the medial side of the patellar tendon and a superficial retinacular tear.*  Injection of normal saline solution was done from the lateral side of the knee.  The knee was insufflated with saline.  There was no leak from the retinacular side. * The medial side of the patellar tendon was repaired, followed by repair of the medial reinaculum. * 0-Vicryl suture in a figure of eight fashion was used to perform both repairs.  Next, 3-0 vicryl in interrupted subcutaneous fashion was used to close the laceration, followed by 3-0 nylon in simple fashion. 

Arthroscopy was then performed.  Lateral portal was established , camera was introduced into he knee. * There was evidence of a significant amount of Methylene Blue inside the knee. *The medial portal was then established, cannula introduced.  *The knee was then thoroughly irrigated with high pressure arthroscopic lavage using 6 liters of saline solution. * There were no medial or lateral meniscus tear, no defect in the cartilage and the ACL was intact in the intercondylar notch. * The knee was thoroughly suctioned*; 10ml of 0.5% Marcaine was injected into the knee.  Arthroscopy instruments were removed and 3-0 Vicryl in interrupted fashion was used to close the portal incision sites.  Sterile dressing were applied, followed by hinged knee brace......"



Would  late effect diagnosis code 905.8 be used for the tendon tears?  If so, What other tendon tear code be used? since the condition or nature of late effect is coded first.  
Would a foreign body diagnosis code be used for the Methylene Blue retained inside the knee?

Any thoughts or opinions are much appreciated! 
For the CPT codes:  27380 for the Patellar tendon, 27559 for the medial retinaculum repair?


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## joanne71178 (Jul 23, 2013)

Anyone have any thoughts?


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## nyyankees (Jul 23, 2013)

joanne71178 said:


> "The patient is a 14 year old male who sustained a bicycle related injury one day ago, landing onto his left knee.  He presented to the emergency room, had a deep medial side laceration to his knee.  The emergency room performed a Methylene Blue dye test with an injection into the left knee, did not appear to communicate with the laceration.  He was irrigated in the emergency room and repair of the laceration was performed.  He was seen in the office today, had significant amount of effusion and pain with range of motion of his knee.  There was some contamination of the laceration site, with erythema."
> 
> The patient was taken to the OR......
> 
> ...



27380 would be correct and 29871 for lavage. I would not bill 27559 for retinaculum but you can try. Not sure if you'll need late effect as it was just not dealt with properly at ER. Use regular tendon tear.


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## joanne71178 (Jul 24, 2013)

THank you!  You're a lifesaver


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