# PF Ligament Reconstruction w/Allograft



## joanne71178 (Apr 11, 2013)

The diagnosis is recurrent patella femoral dislocations w/patella alta.  Recurrent patellar dislocations from soccer injuries and recent rugby injury.  

The incision was made over the medial aspect of the patella. Dissection was carried out between levels 2 and 3 for eventual graft passage and medial border of the patella was exposed after the C-arm was utilized to localize the junction of the superior middle thirds of the patella and inferior mid thirds.  Two guidewires were placed with positions confirmed avoiding the dorsal surface of the patella so as not to create a stress riser.  The 2/4 pins were over drilled with 4.5 mm reamers to create sockets the depth of 20mm.  

An incision was made over the pes anserine region and the gracilis tendon was harvested.  A blunt tendon stripper was used and the length of the tendinous portion of his gracilis tendon was 150mm which was felt to be short for this purpose, therefore, his semitendinosus tendon which had satisfactory size was harvested and 210 mm of the tendon were whip stitched and sized.  The SwiveLock anchors were used on the patella to put the two ends into the patellar area.  A tunnel was created between levels and anterior to the adductor tubercle.  The drill hole was placed to the depth of 30 mm.  A bioabsorbable 7 x 23 mm screw was used which provided excellent fixation.  The graft was tensioned at approximately patella throughout motion.  

After copious irrigation, closure was performed.................

For the diagnosis would 836.3/E007.2 be appropriate?  or 718.3/E007.5?  This is a 15yo boy.

Is the tendon harvest billable? 20999 refer to 20924?

And for the Surgery would 27422 be the correct code?

Thanks in advance!


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## nyyankees (Apr 11, 2013)

joanne71178 said:


> The diagnosis is recurrent patella femoral dislocations w/patella alta.  Recurrent patellar dislocations from soccer injuries and recent rugby injury.
> 
> The incision was made over the medial aspect of the patella. Dissection was carried out between levels 2 and 3 for eventual graft passage and medial border of the patella was exposed after the C-arm was utilized to localize the junction of the superior middle thirds of the patella and inferior mid thirds.  Two guidewires were placed with positions confirmed avoiding the dorsal surface of the patella so as not to create a stress riser.  The 2/4 pins were over drilled with 4.5 mm reamers to create sockets the depth of 20mm.
> 
> ...



I use 836.3 for MPFL. As for CPT I usually use 27427 as 27422 can be used as well (which in turn allows you to use 20924 for the tendon). Unfortunately carriers are requesting 27427 to report MPFL as it doesn't allow capture of an autograft as in your procedure. Orthonet has been giving me a hard time (Oxford, UHC). I have recommended 27427 to my docs unless thy request 27422.


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