# Help in coding



## paula f3 (Apr 28, 2009)

proc: Lt knee arthroscopy w/ posteromedial and lateral menisectomies and separate anterior patellar bony mass excision

The inferomedial and infraportals were established through which the knee was examined and noted to have medicla and lateral meniscal tears.  This was smoothed down to stablize edges using the meniscal shaver. The samll plica was removed anteriorly and a small area of chondromalacia under the kneecap was also debrided.  Attention was then turned to the anterior patella througha 2cm incision.  A large suprapatellar mass was removed , which appeared to be a large gouty tophus.
I coded 29881,  question would I code the mass as 27619,, Im kinda thrown off by the DX  patellar bony mass excision.  Help would be apppreciated 
Paula


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## elenax (Apr 29, 2009)

I would code it, it is a separate incision.


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## ammontagano (Apr 29, 2009)

I agree, due to the separate incisions and also 2 different knee compartments


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## martnel (Apr 29, 2009)

I would use 29880 instead of 29881, since he did medial AND lateral menisectomies.  Also not sure if 27619 is the correct code, since that is for leg/ankle, and not knee area?


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## mbort (Apr 29, 2009)

I agree with martn

Mary, CPC, COSC


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## paula f3 (Apr 29, 2009)

Thanks all for the replys, I was concerned about the mass excision, wondering if the mass excision (gouty tophi) would be considered a bony tissue mass or a soft tissue mass?


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## mbort (Apr 30, 2009)

he calls it a patellar "bony" mass


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## paula f3 (Apr 30, 2009)

yes, the reason for my confusion is that he gives a DX of anterior patellar bony mass, in the body of the dictation he states it to be a large suprapatellar mass. Today I queried him and he said to use CPT 27350, yet when I called his office they told me he coded it  27619, Im just about ready to close my eyes and just pick, just kidding

Paula


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## martnel (Apr 30, 2009)

From medterms.com: Tophus: A nodular mass of uric acid crystals. Tophi are characteristically deposited in different soft tissue areas of the body in gout. The word tophus comes via Latin from the Greek tophos meaning a porous volcanic stone. In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft tissue areas of the body. Even though tophi are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or around the spinal cord!



I would use 27619..


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## coderguy1939 (Apr 30, 2009)

27328 is for thigh and knee area.


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## martnel (May 1, 2009)

Coderguy you got it!  that's right!


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