# I need some help with this surgery



## tony1sue (Mar 12, 2013)

I am looking help in coding this surgery.  I cannot find a cpt code for the:  Open reduction and internal fixation of displaced osteochondral dissecans lesion, medial femoral condyle.  Any help would be greatly appreciated.

Using an anterolateral portal, the right knee was entered. An
anteromedial portal was made under direct visualization using a
spinal needle. Intraoperative findings are described above. We
did identify the osteochondritis dissecans lesion within the
medial femoral condyle as well as a loose fragment within the
suprapatellar pouch and lateral gutter. We were able to grasp
this and remove it. We did have to extend our portal
approximately 1.5 cm in order to be able to extract the loose
fragment. We then entered the lateral compartment. This was not
felt to be a repairable type tear. We therefore debrided this
torn meniscus to a stable border using the biter and shaver.
After completion of the partial meniscectomy, we proceeded to
work with the OCD lesion. Given that this was a completely loose
fragment, we elected to perform a small arthrotomy. We extended
the medial portal incision approximately 4 cm distally. Careful
dissection was carried down to identify the retinaculum. We then
made a medial arthrotomy and then hyperflexed the knee and we
were able to have full visualization of the OCD lesion. We did
remove the fibrous tissue within the bed and attempted to place
the fragment back. We did have to remove some devitalized
cartilage at the periphery in order to allow this to fit. We did
try several different orientations, and, when we felt that we had
the most appropriate fit, we did place a K-wire to temporarily
hold this in place.  We did drill several holes at the base of OCD lesion prior to re-fixation.  
 Then we were able to place 3 BioComposite
headless screws in a triangular type fashion. Each of these did
have appropriate bite and were buried beneath the articular
surface. Following this, I was able to range the knee. There was
no evidence of rocking of the lesion or of catching within the
knee. 
We therefore irrigated the knee, released the tourniquet,
obtained hemostasis, and closed the medial arthrotomy with
Ethibond suture, closed the subcutaneous tissues with Vicryl and
the skin with Monocryl and Dermabond. We did obtain repeat
arthroscopy photos again, showing continued fixation of the
fragments. She was placed in standard sterile dressings and
successfully extubated by Anesthesia. She was transferred to the
postoperative recovery area in stable condition.


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## ccardella (Mar 12, 2013)

I think it's 29855


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## tnadolski (Mar 12, 2013)

Try 29885


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## debwoods65 (Mar 15, 2013)

I like 29885 for this also but I am concerned about the statement that her performed an arthrotomy which leads me to believe he has now taken this procedure into an open and perhaps an open code should be used.  Having said that, I did not find an open code that seemed to fit nicely with what was done.  27355 with the 27358 add-on seems close but a little bit of a stretch.  Not an easy report!   Also, I did see that a medial meniscectomy was done so be sure to account for that.


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