# DESPERATE: ORIF medial femoral condyle osteochondirits disseicans lesion



## AR2728 (Jul 10, 2014)

I am desperate for some guidance on billing this procedure. My surgeon is also unsure how to properly code this procedure. I see that OCD is a covered diagnosis for 27524 ORIF, but not sure that is correct. PLEASE HELP!

PROCEDURE PERFORMED:
1. Right knee open reduction internal fixation medial femoral condyle
osteochondritis dessicans lesion.
2. Right knee arthroscopic partial medial meniscectomy.
3. Right knee arthroscopic loose body removal

Diagnostic arthroscopy ensued. The patient's patella femoral joint was viewed. There was a loose body present. The medial portal was established and the loose body was removed using the shaver. The arthroscope was brought to the medial and lateral compartments. There were no loose bodies. The arthroscope was brought into the medial compartment. The medial meniscus was probed and found to have a complex tear of the posterior horn of the medial meniscus. Using a combination of biters and shavers, this was resected to a stable rim. The medial tibial plateau had an area of grade 3-4 chondromalacia on the periphery. The OCD lesion was viewed. It was found to be intact. It was approximately 2 cm in width x 1.5 cm in length. There was a lateral hinge present. There was fibrous debris present. At this point in time, the ACL was viewed and probed and found to be intact. The lateral meniscus was viewed and probed and found to be intact. At this point in time, fluid was drained from the knee. An arthroscope was removed. Decision was made to perform an open reduction and internal fixation of the OCD lesion. The right lower extremity was exsanguinated. The tourniquet was inflated to 300 mmHg. A medial parapatellar incision was made incorporating the medial portal. Dissection continued down to the capsule. A medial parapatellar arthrotomy was then made taking great care to avoid the meniscus and damage to the cartilage. The knee was then flexed and the OCD lesion was viewed. Fibrous debris was removed. OCD defect was approximately 2 cm x 1.5 cm. However, the bone with cartilage was approximately 1.5 cm x 1.5 cm. There was also approximately 2 cm in depth of the lesion where the lesion was approximately 1.5 cm in depth. This measurement was taken after fibrous debris was removed from the OCD lesion and the defect in the medial femoral condyle. Bleeding bone was then established. 1.5 mm drill holes were placed in the medial femoral condyle to stimulate bleeding. Due to the defect and depth, cancellous allograft bone chips were mixed with DBX putty and packed into the site. Once this was done, the OCD lesion was then pinned in place with a K-wire. Using a lag technique, a 2.7 mm screw was placed in the center of the OCD lesion. A second smart nail was placed. The periphery of the OCD lesion, again, he had two point fixation. Once this was done, the lesion did appear stable. At this point in time the wound was irrigated with normal saline. The defect was palpated and found to be stable. #1 Vicryl suture was used to close the arthrotomy. 2-0 Vicryl suture was used to close......


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## PLAIDMAN (Jul 10, 2014)

I am looking at description of procedure 27415, which seems to meet your needs....it includes excise of lesion, contour bone, allograft and fixation


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## AR2728 (Jul 14, 2014)

Thank you Plaidman! I completely missed the inclusion of fixation for this code. Your advice is much appreciated.


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