# Knee Revision ?



## Sara82 (Apr 21, 2011)

I believe I would code this procedure 27486 - 52. Pretty new to Orthopedics and I just wanted to make sure I have the Polyethylene exchanges/removal correct as my docotor is pretty confused about this surgery. The arthrotomy, synovectomye and bridement would be included? Any responses or advice it much appriciated!


POSTOPERATIVE DIAGNOSIS:
Superficial and deep infection, left total knee.

OPERATIONS PERFORMED:
Left knee arthrotomy, extensive irrigation and debridement,
complete synovectomy, removal of patellar polyethylene, and
polyethylene bearing exchange.

An incision was then made over the concerning area
anteriorly in line with her previous knee incision.  Upon
entering this area, there was a subcutaneous cavity of
granulomatous type tissue, bloody areas of fat necrosis, and
hematoma.  We placed the Yankauer sucker tip into the void and
probed superiorly.  We were able to find a defect in the extensor
mechanism proximally at the site of her previous attempted
patellar tendon repair that communicated with the knee joint.  We
therefore extended our incision and made a medial arthrotomy.  We
elevated off the medial tibia around the deep MCL.  We performed
a complete synovectomy and debridement of the knee with cautery
and sharp dissection.  This involved the suprapatellar pouch,
medial and lateral gutters, posterior aspect of the knee as best
we could access.  The cultures were obtained during this process
prior to any irrigation.  Stat Gram stain was negative for any
bacteria.  We removed the tibial polyethylene and again removed
the patellar polyethylene.  We sort of made a freshening cut on
the patella but did not resurface it.  We continued to debride
any suspicious looking tissues both deep as well as in the
superficial subcutaneous pocket that we had entered initially.
 Any suture from her previous attempted patellar tendon repair
was removed as well.  We ended up irrigating the entire knee with
9 L of bacitracin and saline, performing an extensive
debridement.  We placed a size 10 posterior stabilized Zimmer
NexGen poly for 3 tibia and an E femur.  Decision was made to
leave the implants in place.  We did not yet have any specific
bacteria that had grown on culture.  The patient is very obese
and we felt it was worth an attempt at salvage.


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## nyyankees (Apr 21, 2011)

Sara82 said:


> I believe I would code this procedure 27486 - 52. Pretty new to Orthopedics and I just wanted to make sure I have the Polyethylene exchanges/removal correct as my docotor is pretty confused about this surgery. The arthrotomy, synovectomye and bridement would be included? Any responses or advice it much appriciated!
> 
> 
> POSTOPERATIVE DIAGNOSIS:
> ...



Yes..27486-52 is the correct code..but I always offer my doc the option of NOT adding a 52 modifier if he feels he did more work that just a poly exchange as the 52 mod is not always set in stone..


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