# Hemipatellectomy includes ???



## raemitch78 (Apr 13, 2010)

I need some help on this one...  

The doc states to charge: 27350, 27340, 20680, 27310.

According to NCCI, all are included in the 27350 - hemipatellectomy... I am new to Ortho coding and think that a -59 may be justified on some codes??  Can someone give me some input???

OP NOTE READS:

PROCEDURE: Removal of hardware, resectionof the prepaterllar bursa, resection & partial patellectomy w/extensive irrigation & debridement and primary wound closure.  

Description:  Incision created in old incision line ellipticizing old scar.  Dissection carried down to subcuticular tissue.  A resection of prepatellar bursal & extensive scar tissue on the patella performed.  Dissection was then carried out down about the tibial tubercle & up to just above the patella into the tendon.  The dissection was carried out.  the hardware was identified.  Further soft tssue & debris was removed.  Cultures obtained.  Hardware removed.  The nonunion is noted.  The inferior pole of the patella is removed and dissected free from the patella tendon.  Following this, the arthrotomy was noted.  Extensive synovectomy was carried out.  The wound was then thoroughly & extensively copiously irrigated.  Following this, final cultures obtained.  Next, drill holes were made from the superior pole of patella through the distal aspect of the superior fragment.  Two #2 sutures of No 5. Tycron were weaved through the patella tendon.  These have been passed through the inferior pole of the patella on the most inferior aspect & pulled superiorly & tied over the top of the superior aspect of the patella, allowing the patellar tendon to be advanced to the inferior pole of fragment of patella remaining.  The suture then secured.  Hemovac drains placed deep exiting secondary portals.  Further dissection & removal of soft tissue of the prepatellar bursa is carried out as well as further debridement of the fragment of the patella.  This was sent to pathology.  Site irrigated and closed.


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## JMeggett (Apr 13, 2010)

Hi!  The removal of previous hardware is considered inclusive to the procedure because it's necessary to accomplish this procedure.  And yes, the 27310 & 27340 are also inclusive to the hemipatellectomy.  He did mention "extensive synovectomy".  I wish he had added more of WHY the extensive synovectomy or debridement was needed.....was there excessive scar buildup where the previous hardware was?  If he had dictated the "why" I would maybe consider adding modifier -22 to the 27350, all things considered.  

Jenna, CPC


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## raemitch78 (Apr 13, 2010)

Thanks so much Jenna.  I really appreciate your expertise.  

If anyone else has an opinion, I would love to hear it.  Thanks!!!


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