Hi list 
I am hoping you experts out there can provide me some assistance. I am still fairly new to Ortho coding.
I am getting an edit for codes 29867 & 29879.
Tia
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Chondral defect Right trochlea
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURES:
1. Osteochondral allograft implantation right trochlea (27415)
2. Arthroscopic microfracture right trochlea. (29879)
SURGEON:
, M.D.
ASSISTANT:
PA was crucial for the entirety of the procedure.
There was no qualified resident available.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
50cc
IV FLUIDS:
1100cc
INDICATIONS FOR PROCEDURE:
a 36 y.o. male with right knee injury while
stepping off of a curb 1 week ago. Of note, he had
intramedullary nail and subsequent hardware removal 10 years
ago on his right tibia. He felt a pop and had swelling after
the injury as well as difficulty bending and instability. He
denies any patellar instability. He had an MRI that showed a chondral defect over his trochlea. He was advised the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
He was brought to the operating room, placed supine on the OR
table, underwent general anesthesia without difficulty. Preop time-out was
done identifying his Right knee as the operative knee. He was given preoperative antibiotics in the holding area.
His examination under anesthesia revealed a stable Lachman, stable to varus
and valgus stress, stable anterior and posterior drawer.
He was placed in nonsterile tourniquet and prepped and draped in sterile fashion using ChloraPrep. His limb was elevated, exsanguinated and tourniquet was raised.
Standard diagnostic arthroscopy was begun using anteromedial and anterolateral portals with the following findings:
There was no chondromalacia on his patella that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver. He had grade 4 chondromalacia involving the trochlea that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and a ring curette in preparation for later microfracture and biocartilage. The medial joint had no chondromalacia on the medial femoral condyle and no chondromalacia on the medial tibial plateau. The meniscus was not torn. The intercondylar notch revealed an intact ACL and PCL. The lateral joint had no chondromalacia on the lateral femoral condyle and no chondromalacia on the lateral tibial plateau. The meniscus was not torn. We examined the medial and lateral gutter for any further
Pathology or loose bodies. There was none.
We then turned our attention to the microfracture portion of the case. A 45 degree PowerPic was used to make 8 pilot holes in the 1.5x1cm lesion. We then placed the allograft biocartilage in the defect intentionally underfilling the defect. The Biocartilage was smoothed with a Freer elevator. We then used fibrin glue to secure then lesion with an even layer. The glue was allowed to cure for 7 minutes. The knee was then ranged and the Biocartilage was stable.
We then removed the arthroscopic tools from the joint, closed both portals using interrupted 3-0 nylon stitches in a
simple fashion. Both portals were injected with 0.5% ropivacaine without
epinephrine. Xeroform, dressing sponges, two ABDs, Webril, and an Ace wrap were
applied. The patient tolerated the procedure well and was transferred to
recovery room in stable condition.
Postoperatively, can be weightbearing as tolerated on his Right lower extremity. We will see him back in 10-14 days for repeat evaluation and suture removal. He can start physical therapy in 1-3 days on my biocartialge/microfracture protocol with patellofemoral restrictions.
I am hoping you experts out there can provide me some assistance. I am still fairly new to Ortho coding.
I am getting an edit for codes 29867 & 29879.
Tia
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Chondral defect Right trochlea
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURES:
1. Osteochondral allograft implantation right trochlea (27415)
2. Arthroscopic microfracture right trochlea. (29879)
SURGEON:
, M.D.
ASSISTANT:
PA was crucial for the entirety of the procedure.
There was no qualified resident available.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
50cc
IV FLUIDS:
1100cc
INDICATIONS FOR PROCEDURE:
a 36 y.o. male with right knee injury while
stepping off of a curb 1 week ago. Of note, he had
intramedullary nail and subsequent hardware removal 10 years
ago on his right tibia. He felt a pop and had swelling after
the injury as well as difficulty bending and instability. He
denies any patellar instability. He had an MRI that showed a chondral defect over his trochlea. He was advised the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
He was brought to the operating room, placed supine on the OR
table, underwent general anesthesia without difficulty. Preop time-out was
done identifying his Right knee as the operative knee. He was given preoperative antibiotics in the holding area.
His examination under anesthesia revealed a stable Lachman, stable to varus
and valgus stress, stable anterior and posterior drawer.
He was placed in nonsterile tourniquet and prepped and draped in sterile fashion using ChloraPrep. His limb was elevated, exsanguinated and tourniquet was raised.
Standard diagnostic arthroscopy was begun using anteromedial and anterolateral portals with the following findings:
There was no chondromalacia on his patella that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver. He had grade 4 chondromalacia involving the trochlea that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and a ring curette in preparation for later microfracture and biocartilage. The medial joint had no chondromalacia on the medial femoral condyle and no chondromalacia on the medial tibial plateau. The meniscus was not torn. The intercondylar notch revealed an intact ACL and PCL. The lateral joint had no chondromalacia on the lateral femoral condyle and no chondromalacia on the lateral tibial plateau. The meniscus was not torn. We examined the medial and lateral gutter for any further
Pathology or loose bodies. There was none.
We then turned our attention to the microfracture portion of the case. A 45 degree PowerPic was used to make 8 pilot holes in the 1.5x1cm lesion. We then placed the allograft biocartilage in the defect intentionally underfilling the defect. The Biocartilage was smoothed with a Freer elevator. We then used fibrin glue to secure then lesion with an even layer. The glue was allowed to cure for 7 minutes. The knee was then ranged and the Biocartilage was stable.
We then removed the arthroscopic tools from the joint, closed both portals using interrupted 3-0 nylon stitches in a
simple fashion. Both portals were injected with 0.5% ropivacaine without
epinephrine. Xeroform, dressing sponges, two ABDs, Webril, and an Ace wrap were
applied. The patient tolerated the procedure well and was transferred to
recovery room in stable condition.
Postoperatively, can be weightbearing as tolerated on his Right lower extremity. We will see him back in 10-14 days for repeat evaluation and suture removal. He can start physical therapy in 1-3 days on my biocartialge/microfracture protocol with patellofemoral restrictions.