Sara82
Guru
11983 & 27130 are the codes Im getting from teh Op Note. Insurance is denying 27130 with 11983. I dont see any edits for these two codes to be charged together. Has anyone come across a similiar scenerio?
OPERATION PERFORMED:
1. Arthrotomy, removal of dislocated spacers and placement of
non- articulating antibiotic block spacer.
2. Open reduction and internal fixation, medial femoral condyle
fracture.
As combination of tibial femoral
instability as well as the patella, it subluxed again. She has
clearly torn the repair of her extensor mechanism. The wound was
aggressively scrubbed with hexachlorophene and then ultimately
prepped. We opened the knees through the previous midline
incision. Medial and lateral subcutaneous flaps were elevated
and this was done around the open area which was probably 5 cm x
4 cm in the midportion of her knee. This granulation tissue was
debrided as well. There was 1 part of the superior medial border
of the patella where this went right into the knee. This was
obviously where she had ripped her advancement of the VMO repair.
We identified the quadriceps tendon and opened through a medial
parapatellar approach. The inside of the knee did not look
terrible. A lot of blood. No real purulent material. Cultures
were taken. The Gram stain was negative for organisms. We
gained some exposure around the medial side of the tibia. We
were able to flex the knee up. The femoral component was firmly
fixed to the bone. Painstaking effort was taken to try to free
this up. Her bone was very soft, and as we tried to free up the
Prostalac prosthesis, it was noted to have a crack in the medial
femoral condyle. This went more or less vertically from the
notch up, shearing off the medial femoral condyle. We gingerly
removed the remainder of the cement block. We gingerly removed
the cement off the proximal tibia. We removed the cement from
the back of the knee, curetted all the surfaces and irrigated 3
liters of antibiotic solution through. Ultimately we placed two
6.5 mm cancellous screws across the medial femoral condyle,
anchoring it back to the femur. This reduced the fracture
reasonably. Her bone was quite soft. It was sort of less than
ideal but I wanted to minimize the amount of hardware placed in
her previously infected wound. We then mixed up four bags of
cement, containing a total of 8 g of vancomycin and 8 g of
tobramycin, 4 g of gentamicin. This was all mixed up, placed in
the nonarticulating spacer, a little bit into the tibia and a
little bit up into the femur, further splinting the medial
femoral condyle fracture. This was allowed to harden while we
irrigated to keep the temperature down. Once we were happy the
cement was hardened and we had decent soft tissue coverage, we
cleaned up the soft tissue edges. We addressed the subcutaneous
tissues and began closing. We closed over a single drain. The
arthrotomy was closed down to the superior pole of the patella
fairly easily. We then had to more or less fashion the sleeve in
the area of the defect to bring this over to the patella on the
medial side. The inferior portion along the patella tendon was
closed without difficulty as well. Once the arthrotomy was
closed in full extension, we cleaned up the edges of the open
area of her missing skin basically and closed in a longitudinal
fashion until this was no longer possible. This left the same
probable 5 x 4 cm defect with nice clean edges. Xeroform gauze
was packed around ______ dressing was applied. The patient was
placed in a knee immobilizer and transferred to the recovery room
in stable condition.
OPERATION PERFORMED:
1. Arthrotomy, removal of dislocated spacers and placement of
non- articulating antibiotic block spacer.
2. Open reduction and internal fixation, medial femoral condyle
fracture.
As combination of tibial femoral
instability as well as the patella, it subluxed again. She has
clearly torn the repair of her extensor mechanism. The wound was
aggressively scrubbed with hexachlorophene and then ultimately
prepped. We opened the knees through the previous midline
incision. Medial and lateral subcutaneous flaps were elevated
and this was done around the open area which was probably 5 cm x
4 cm in the midportion of her knee. This granulation tissue was
debrided as well. There was 1 part of the superior medial border
of the patella where this went right into the knee. This was
obviously where she had ripped her advancement of the VMO repair.
We identified the quadriceps tendon and opened through a medial
parapatellar approach. The inside of the knee did not look
terrible. A lot of blood. No real purulent material. Cultures
were taken. The Gram stain was negative for organisms. We
gained some exposure around the medial side of the tibia. We
were able to flex the knee up. The femoral component was firmly
fixed to the bone. Painstaking effort was taken to try to free
this up. Her bone was very soft, and as we tried to free up the
Prostalac prosthesis, it was noted to have a crack in the medial
femoral condyle. This went more or less vertically from the
notch up, shearing off the medial femoral condyle. We gingerly
removed the remainder of the cement block. We gingerly removed
the cement off the proximal tibia. We removed the cement from
the back of the knee, curetted all the surfaces and irrigated 3
liters of antibiotic solution through. Ultimately we placed two
6.5 mm cancellous screws across the medial femoral condyle,
anchoring it back to the femur. This reduced the fracture
reasonably. Her bone was quite soft. It was sort of less than
ideal but I wanted to minimize the amount of hardware placed in
her previously infected wound. We then mixed up four bags of
cement, containing a total of 8 g of vancomycin and 8 g of
tobramycin, 4 g of gentamicin. This was all mixed up, placed in
the nonarticulating spacer, a little bit into the tibia and a
little bit up into the femur, further splinting the medial
femoral condyle fracture. This was allowed to harden while we
irrigated to keep the temperature down. Once we were happy the
cement was hardened and we had decent soft tissue coverage, we
cleaned up the soft tissue edges. We addressed the subcutaneous
tissues and began closing. We closed over a single drain. The
arthrotomy was closed down to the superior pole of the patella
fairly easily. We then had to more or less fashion the sleeve in
the area of the defect to bring this over to the patella on the
medial side. The inferior portion along the patella tendon was
closed without difficulty as well. Once the arthrotomy was
closed in full extension, we cleaned up the edges of the open
area of her missing skin basically and closed in a longitudinal
fashion until this was no longer possible. This left the same
probable 5 x 4 cm defect with nice clean edges. Xeroform gauze
was packed around ______ dressing was applied. The patient was
placed in a knee immobilizer and transferred to the recovery room
in stable condition.