# need help coding knee arthroscopy



## twosmek (Feb 15, 2011)

here is the operative note.

_PREOPERATIVE DIAGNOSES:
1.  Bipartite patella.
2.  Patellar chondromalacia.
3.  Lateral patellar impinging osteophyte.

POSTOPERATIVE DIAGNOSES:
1.  Bipartite patella.
2.  Patellar chondromalacia.
3.  Lateral patellar impinging osteophyte.
4.  Medial and lateral meniscus tear.
5.  Chondromalacia lateral tibial plateau (grade III-A).

SURGICAL PROCEDURES:
1.  Right knee arthroscopic lateral release.
2.  Arthroscopic debridement and excision of lateral patellar osteophyte.
3.  Arthroscopic partial medial and lateral meniscectomies.

SURGEON:
XXXXXXXX

ANESTHESIA:
General anesthesia.

ANESTHESIOLOGIST: 
XXXXXXXXXX

ARTHROSCOPIC FINDINGS:
The patellofemoral joint demonstrated somewhat lateralize tracking of the patella.  The superolateral facet adjacent to the area of unknown bipartite patella was noted to be tightly interdigitated rounded off with the lateral patellar retinaculum which created a dense adhesion in the superolateral gutter.  This was fairly smooth and was not clear bone but was bone intermixed with soft tissue off the lateral retinaculum.  The patella showed fissuring and 2B softening of the high point and medial facet.  Trochlea showed minimal chondromalacia.  The intercondylar notch demonstrated intact ACL.  Medial compartment showed normal appearing articular cartilage surfaces.  The medial meniscus had an inner rim degenerative type tear comprised approximately the inner one-third of the meniscus between 12 o'clock and 4 o'clock.  The lateral compartment showed diffuse softening as well as a deep fissure on the weightbearing articular surface of the tibial plateau as well as a degenerative type tear of the inner one-third of the meniscus between 12 o'clock and 8 o'clock.

SURGICAL TECHNIQUE:
The patient was brought to the operating room and administered a general anesthetic.  Her right lower extremity was then prepped and draped in the usual sterile fashion.  The limb was exsanguinated with an Esmarch bandage.  Tourniquet was insufflated to 300 mmHg.  Medial and lateral arthroscopic portals were then established with an 11 blade.  The arthroscopic findings are as described above.

Partial medial and partial lateral meniscectomies were then performed for the fairly small inner rim degenerative tears.  These were then taken back to healthy tissue using basket biting resectors.  The remaining rim was then smoothed with soft tissue full radius resector.

The patellofemoral joint was then addressed.  The dense adhesion along the superolateral gutter was released with a thermocautery hook to perform a lateral release from the margin of the distal vastus lateralis through the retinaculum down to and just past the anterolateral portal.  This allowed better visualization of the lateral facet of the patella which had overhang bony extension into the retinaculum and then what appeared to be calcified retinaculum along the area of the bipartite patella.  This was felt to be contributing to impingement and soft tissue irritation.  The soft tissue was then ablated using a thermocautery ablation device to further define the anatomy.  A burr as well as a soft tissue resector were then used to trim any remaining edge to the bipartite edge of the patella and lateral facet.  This was then smoothed with the full radius resector.  The tourniquet was then let down in pulses to allow for assistance with hemostasis in the lateral release area.  This was done with the thermocautery hook.  An additional portal had been established along the lateral margin of the patella to assist with access to the lateral portion of the patella.  These portals were then closed with interrupted 3-0 nylon suture.  A well padded gauze dressing with a lateral pad was then applied._

I was thinking that the CPT would be either
29880 for the Partial Medial and Lateral Menesectomies
29873 for the Lateral Release to include the debridement--PF compartment 

Or.
29880: PMM/PLM
29879: Debridment of oseophyte
29873: lateral release.

This is NOT a Medicare patient.  Any and all help would be greatly appreciated.  Thanks


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## khopstein (Feb 15, 2011)

I would do 29880 and 29873. I believe the debridement is included in 29873. It seems like he would have to mention drilling or chondral picking to bill 29879.


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## twosmek (Feb 15, 2011)

Thanks, That is what I was ultimately thinking as well.


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