# Acl reconstruction open or arthroscopically aided



## cwilson3333 (Dec 13, 2013)

Not sure is this is 29888 or 274727.
Doctors operative note says: 
Procedure:  Anterior Cruciate Liagment reconstruction with hamstring autograft.

Brief description states....arthroscope placed in lateral portal......patellofemoral joint visualized....medial compartment examined....complete tear of one of bundles of ACL and stretching of other bundle....lateral compartment examined.
At this point, arthroscopic equipement was removed.....incision taken down through subcutaneous tissues...fascia overling pes tendon incised...fiberwire placed in whipping fashion along distal aspecdt tendon...tendon harvested..........torn ACL removed with use of up-biter and shaver.......notchplasty performed....guide pin placed....femoral tunnel reamed.....suture placed through both tunnels.....graft placed......Tightrioe as well as sutures placed through a Swivel-Lock suture anchor.  Skin closed with subcuticular suture....marcaine and epinephrine placed in soft tissues....patient extubated and transferred in stable condition.

Hope I have enough of op note for an answer of :
Arthroscopic ACL or Open ACL

Thanks


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## sangeethalakshmi (Dec 13, 2013)

This procedure should be reported as Open ACL. OP note clearly indicates that an open approach has been done after trying to do the procedure arthroscopically.
Make sure to add the diagnosis code V64.43 (Arthroscopical procedure converted to open as secondary or tertiary diagnosis)


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## joanne71178 (Dec 13, 2013)

I agree it ;  Open code w/the V code


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## cwilson3333 (Dec 13, 2013)

*ACL Response*

*Thanks to alll who responded.*


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## twizzle (Dec 14, 2013)

cwilson3333 said:


> Not sure is this is 29888 or 274727.
> Doctors operative note says:
> Procedure:  Anterior Cruciate Liagment reconstruction with hamstring autograft.
> 
> ...


It's a terrible operative report but it sounds like the arthroscopic part was purely diagnostic with no intention to attempt an arthroscopic reconstruction. If so you wouldn't use the V code as a secondary diagnosis.
By the way, open ACL reconstruction is intra-articular therefore you would use 27428, not 27427 as you stated.


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## melzinser (Dec 16, 2013)

*intra or extra articular*

True Blue: could you point out the specific part of the narrative in the edited Op note that makes you say the ACL repair was done intra-articularlly, or are you just assuming that because MOST ACL repairs are done that way?  I have read they can be done both intra- or extra-articular.


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## twizzle (Dec 16, 2013)

*ACL reconstruction*

Melanie...you are of course correct. However , it seems as if the intra-articular approach is the preferred method nowadays. Certainly, all my surgeons do an intra-approach so I guess I was assuming the whole world did. I was taught that ACL repair was intra, and that MCL, LCL, and MFPL are all extra.


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## cwilson3333 (Dec 16, 2013)

*ACL Open or Scope*



wassock said:


> It's a terrible operative report but it sounds like the arthroscopic part was purely diagnostic with no intention to attempt an arthroscopic reconstruction. If so you wouldn't use the V code as a secondary diagnosis.
> By the way, open ACL reconstruction is intra-articular therefore you would use 27428, not 27427 as you stated.



Thank you for taking the time to respond.  Of course "my brief" operative note is just that....brief. The original operative note is much more detailed.  And the typos didn't help.

CW


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