# ARthroscopic converted to open



## vmounce (Feb 1, 2010)

Another coder says to use 29870 and 27422.  NCCI policy say if arthroscopic procedure is converted to open to use the open code.  Only if is in different joints should I use both.  Is this correct?  See below.  I appreciate the help.

Vickie    

PROCEDURE:   Diagnostic arthroscopy and open medial plication.

OPERATIVE PROCEDURE:   The patient was brought to the operating theatre and once general anesthesia was administered, the leg was placed in a tourniquet and leg holder.  The extremity was sterilely prepped and draped in the usual manner, exsanguinated, and the tourniquet inflated to 200 mmHg.

Anterolateral arthroscopy portal was made and the arthroscope was introduced and diagnostic arthroscopy was carried out.  The suprapatellar pouch was entered and the patellofemoral joint was visualized.  There were a few fissures in the central portion of the patella.  The patella was easily subluxatable laterally to a near dislocation with the knee in full extension.  The trochlear groove was shallow.  The medial gutter was clean.  The medial compartment was normal.  The intercondylar notch revealed an intact ACL.  The lateral compartment was pristine and the lateral gutter was clean.  

The arthroscope was removed and water was expressed from the knee.  The table was brought into full extension.  A 4 cm slightly oblique incision was made over the anteromedial aspect of the knee just medial to the patella and carried through the skin sharply.  Soft tissue was divided and the quadriceps tendon at its insertion of the patella was exposed.  Hemostasis was obtained as the quadriceps tendon was divided leaving a cuff of tissue along the patella from its midportion extending proximally a distance of 5 cm.  With the quadriceps tendon divided, it was then oversewn over the superior aspect of the quadriceps tendon to near midline.  Once secured with #2 Ethibond x 3 in a figure-of-eight, the leading edge of the tendon was oversewn in a running fashion to the quadriceps tendon.


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## mitchellde (Feb 1, 2010)

In this instance I say no as the arthroscopic was only diagnostic the definitive procedure was open.  This to me is not even a conversion just an open.


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## vmounce (Feb 1, 2010)

i REALLY APPRECIATE THE REPLY.  THANKS AGAIN.


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