# Please help code short report.



## coders_rock! (Feb 28, 2012)

Pre/Post-Operative Diagnosis: Status post right total knee replacement w/arthrofibrosis. 

Operation: RT total knee replacement, open lysis of adhesions, exchange of polyethylene liner, lateral release & quadriceps plasty. 

PROCEDURE: A midline incision was performed followed by a medial parapatellar arthrotomy.  A proximal medial release in the tibia was performed.  The patella was partially everted and then a Mayo scissors was used to lyse the adhesions in both the medial and lateral gutters and in the suprapatellar pouch.  Once the quadriceps tendon was mobilized, it was decided to do a lateral release, which would further enhance our exposure.  This started several centimeters distal to the articular surface and extended proximally well up into the belly of the vastus lateralis muscle.  This was an inside out lateral release performed about a centimeter lateral to the lateral edge of the patella.  Once this was done, the knee was slowly flexed up.  Any scar tissue was debrided from about the articular surface about the joint and again from the gutters in the suprapatellar pouch.

Next, the polyethylene insert was removed in the tibial tray.  This was a size #11 in thickness and we went through a 9-mm Hi-Flex trial insert.  The patient's range of motion prior to starting the procedure demonstrated about a 10-degree flexion contracture and flexion to about 40 degrees.  With this new trial in, gentle pressure into hyperextension was performed and an audible tearing of tissues from the posterior aspect of the knee could be heard and the knee fell into full extension without a significant amount of force.  Flexing the knee with the extensor mechanism closed resulted in flexion to approximately 100 degrees of flexion.  This was enhanced further by doing a pie crust technique of the quadriceps tendon with a #15 blade.  After the debridement of the scar tissue was performed, the lateral release, and quadriceps plasty, it was decided that no further surgery would be required Patient did well

Thank you,


----------



## JMeggett (Feb 28, 2012)

coders_rock! said:


> Pre/Post-Operative Diagnosis: Status post right total knee replacement w/arthrofibrosis.
> 
> Operation: RT total knee replacement, open lysis of adhesions, exchange of polyethylene liner, lateral release & quadriceps plasty.
> 
> ...



I would code this as 27486 Revision of total knee arthroplasty, 1 component, with 27430 Quadricepsplasty.  The lysis of adhesions and lateral release are included/bundled in the 27486 per CCI edits.  
Jenna


----------

