# Scar revision



## LIVE2CODE (Sep 20, 2017)

HELP!! Is this enough for Complex repair 13120 or do need to ask for an addendum? 

The left knee was then opened with #10 blade.  A Subvastus approach performed.  There was extensive adhesions and scar tissue within the medial and lateral gutters and the suprapatellar pouch.  We excised this with cautery.  Once we did this we had improved flexion to 115 degrees.  We then cleaned out around the PCL and improved flexion to 125 degrees.  I then assessed extension, which was full.  I released the tourniquet, got good hemostasis and injected the local cocktail around the knee.  I then wash with pulsatile lavage containing Rifampin.  A Hemovac drain was placed.  The wound was then closed with #2 Quill, 2-0 Vicryl and staples.


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## sxcoder1 (Sep 21, 2017)

I've been perplexed with this scenario myself, but I think they're calling it a scar revision when they're actually removing scar tissue inside the knee joint so I'm not sure 13120 is correct.  I have used an open arthrotomy code in the past.  I'd like to hear other opinions though!


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## LIVE2CODE (Sep 21, 2017)

sxcoder1 said:


> I've been perplexed with this scenario myself, but I think they're calling it a scar revision when they're actually removing scar tissue inside the knee joint so I'm not sure 13120 is correct.  I have used an open arthrotomy code in the past.  I'd like to hear other opinions though!




It would be great to hear other suggestions as well.

I thought about the arthrotomy code, but its not documented that he enter the joint capsule, just like the diameters of the wound is not mentioned. Per CPT guidelines; Complex repair includes the repair of wounds requiring more than layered closure, viz., scar revision, debridement (eg, traumatic lacerations or avulsions), extensive undermining, stents or retention sutures. Necessary preparation includes creation of a limited defect for repairs or the debridement of complicated lacerations or avulsions. :confused


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## thomas7331 (Sep 21, 2017)

A scar revision reported with a complex closure code is an integumentary procedure and would be more appropriate for a skin or superficial subcutaneous scar - it's not really accurate coding for what's documented here.  I agree that an arthrotomy appears to be most correct for this - provider does appear to be working in the joint based on the approach and the structures involved, but you may wish to run it by the physician for clarification and/or addendum if you feel the code would be better supported with language to document actually entering the capsule.  Otherwise an unlisted code might be necessary.  The reimbursement for an arthrotomy is about 3 times that of a complex closure which would significantly underpay the work here.


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## AlanPechacek (Sep 21, 2017)

Based on the information provided, this was an Arthrotomy of the Knee for Intra-Articular Scarring and/or Adhesions causing limitation of motion (Ankylosis) of the joint, particularly in flexion.  The scarring/adhesions were/are the result of some prior "event" in the knee, i.e. trauma or previous surgery.  In my experience, the most common preceding "event" is a TKR (with or without any other contributing complication) in which satisfactory postoperative range of motion is not achieved, particularly in flexion.  Therefore, and if it has been too long after the surgery for a joint manipulation under anesthesia to be done safely or with a reasonable chance of success, an Arthrotomy is performed for the release and removal of the offending scar tissue/adhesions so as to regain as much flexion as possible.  In this case, an Anterior Synovectomy (only) was performed.  The most accurate code for this is 27334.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## LIVE2CODE (Sep 22, 2017)

AlanPechacek said:


> Based on the information provided, this was an Arthrotomy of the Knee for Intra-Articular Scarring and/or Adhesions causing limitation of motion (Ankylosis) of the joint, particularly in flexion.  The scarring/adhesions were/are the result of some prior "event" in the knee, i.e. trauma or previous surgery.  In my experience, the most common preceding "event" is a TKR (with or without any other contributing complication) in which satisfactory postoperative range of motion is not achieved, particularly in flexion.  Therefore, and if it has been too long after the surgery for a joint manipulation under anesthesia to be done safely or with a reasonable chance of success, an Arthrotomy is performed for the release and removal of the offending scar tissue/adhesions so as to regain as much flexion as possible.  In this case, an Anterior Synovectomy (only) was performed.  The most accurate code for this is 27334.
> 
> Respectfully submitted, Alan Pechacek, M.D.
> icd10orthocoder.com



You are correct patient is 6months status post LT/TKA, postop DX Ankylosis. Now my doctor feels that manipulation will not be beneficial at this point and proceeded with this surgery. I like the Arthrotomy code better after farther review.. Thank you for your help


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## sxcoder1 (Sep 25, 2017)

Thank you Dr. Pechacek for finally clarifying this perplexing scenario for me!


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