# ORIF osteochondral patella fragment??



## KristinM522 (Jul 15, 2017)

Can anyone help with how they would code this? I almost want to just code it as an ORIF patella (27524) but not sure if that's the right way to go. Op note below..

Post-operative Diagnosis:
Left knee Knee osteochondral fracture of the patella

Procedure Performed:
Open reduction internal fixation of left knee osteochondral patellar fragment, microfracture of
patella, removal of loose bodies from knee, repair of medial retinaculum.


The patient was identified and brought to the operating room. After general anesthesia the
knee was examined under anesthesia was no significant ligamentous instability. Midline
incision was made and the skin was mobilized to view the joint capsule. Initially there was no
obvious tear in the medial retinaculum. A median parapatellar approach was utilized to
expose the patella and during this it was noted that there was a tear in the medial retinaculum
that we utilized to open the joint. The joint was then exposed and the patella was inverted.
The large osteochondral fragment was identified in the lateral gutter and removed. There
was a smaller osteochondral fragment that had very little bone on it that was also found in the
intercondylar notch. The rest of the joint was visualized after a thorough irrigation and there
was no further fragments were visualized. First the patella was examined and it was noted
that the majority of the cartilage that had sheared off came off of the inferior half of the patella
and was primarily on the medial side. This area was then curetted to remove any hematoma
and the large fragment was then placed in the position and fit excellently. This was secured
with 2, 2.5 mm screws that were countersunk down to the subchondral bone. A 1.5 mm
screw was also placed to further secure the fragment. Excellent fixation was obtained. On
the medial side of the patella there was bare spot where the smaller fragment came from.
This piece was not repairable therefore a 1 mm drill was utilized to perform a microfracture in
the area. At this point the wound was irrigated copiously.


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## KristinM522 (Jul 19, 2017)

Does anyone have any idea on this one?? I'd appreciate any one else's insight, I've looked at it for so long I may end up coding it as a shoulder fracture in the end  lol


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## daedolos (Jul 19, 2017)

I'm 100% sure it's not the shoulder CPT code.

Peace
@_*
https://www.aaos.org/AAOSNow/2010/May/managing/managing2/


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## AlanPechacek (Jul 19, 2017)

Yes.  This is an Open Treatment of a Patellar Fracture with Internal Fixation: 27524.  This would be correct for the Osteochondral Fracture in this case.  I would tend to include the Drilling of the area left uncovered by the loss of articular cartilage in this code, and the repair of the Medial Retinaculum as well.  I suspect that the surgeon was dealing with a Traumatic Patellar Dislocation that resulted in all of these abnormal findings even, though the Operative Report doesn't say so explicitly.

Hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## KristinM522 (Jul 19, 2017)

Thank you so much for your response! I really appreciate it.

I hope you both know I was totally kidding about the shoulder code, my way of saying I was looking at it way to hard!

Have a great evening!


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## cwilson3333 (Apr 5, 2019)

*Osteochondral Fracture and Tibial Tubercle Osteotomy*



AlanPechacek said:


> Yes.  This is an Open Treatment of a Patellar Fracture with Internal Fixation: 27524.  This would be correct for the Osteochondral Fracture in this case.  I would tend to include the Drilling of the area left uncovered by the loss of articular cartilage in this code, and the repair of the Medial Retinaculum as well.  I suspect that the surgeon was dealing with a Traumatic Patellar Dislocation that resulted in all of these abnormal findings even, though the Operative Report doesn't say so explicitly.
> 
> Hope this helps.
> 
> ...



Just came across your reply to this coding issue, and have similar case I need to check coding on and hopefully get your advice.
Diagnosis:  Dislocation patella with osteochondral injury and Increased Q Angle

Procedures planned are ORIF osteochondral fracture [27524]
                             and Tibial Tubercle Osteotomy with lateral retinaculum release 27418 or 27420

Would appreciate your advice

Thank you Doctor


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