# (POD) Professional Vs. Facility



## hstefani (Jul 13, 2010)

Help! I have a discrepancy between the podiatry physician & the ASC coding.  Can you please review this note & give me your suggestions?

Provider coding: 27640-LT, 28120-51/LT, 29898-51/LT, 76000-59/26
Facility coding: 29898-LT

Procedure(s):
1. Ostectomy anterior tibial plafond left
2. Ankle arthroscopy with extensive debridement left
3. Ostectomy to dorsal talar neck left
4. Fluoroscopic assistance

Implant(s): None

Hemostasis: Thigh tourniquet @ 300 mm Hg for 40 minutes

Estimated blood loss: Less than 50 ml.

Operative Findings: Large impinging osteophytes anterior tibial plafond medial 
malleolus, dorsal and medial talar neck. Full thickness cartilage erosion dorsal
talar surface. Lateral Bassets lesion. Extensive fibrosis medial and lateral 
gutters.

The patient was brought to the operating room placed on the operating table in a supine position. General anesthesia was administered. A surgical time out was performed by the staff identifying the appropriate side in site. The left lower extremity was prepped and draped the sterile manner technique.

Standard medial and lateral ports were fashioned the ankle joint. The arthroscope was introduced into the joint. Extensive fibrosis was encountered in the medial lateral and care portion of the ankle joint which was debrided with a full radius resector. There was a lateral Bassets lesion impinging of the lateral short of the talus which was resected using combination of basket punches and full radius resector.

The anterior osteophytes were then removed with a combination of osteotomes and rotary burr. Once the osteophytes are removed there is noted to be significant chondral trough in over the dorsal talar surface secondary to the osteophytes. No osteochondral defects or flaps were encountered. Once the anterior ankle joint was decompressed both soft tissue pathology and osteophytes intraoperative fluoroscopy was used to verify removal of the anterior spurring.

The cuff was deflated hemostasis verified and both portals were closed simple nylon suture.

A well padded sterile bandage was applied.


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## ASC CODER (Jul 14, 2010)

Under Code 29898 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive -- AAOS states included is articular shaving, chondroplasty and debridement so this might be your code -- Included: "12. articular shaving, debridement, and/or chondroplasty, limited (eg,29897); 13. removal of osteophytes; 14. manipulation under anesthesia (eg, 27860)"  and Excluded: "arthroscopic removal of loose or foreign bodies greater than 5 mm or through a separate incision (eg, 29894); 4. arthroscopic synovectomy (eg, 29895)"

copied from code correct


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## hstefani (Jul 14, 2010)

Awesome! Thank you so much. That was extremely helpful.


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