I have 29888 29882 29881 29879?? I am still fairly new to Ortho coding. Can someone please agree/disagree. Thanks!
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Right anterior cruciate ligament tear medial and lateral meniscus tears. Chondromalacia MFC/LFC
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE:
1. Anatomic Right arthroscopic ACL reconstruction using an 8 mm femur/9mm tibia hamstring autograft.(29888)
2. Arthroscopic Right Medial meniscus repair (29882)
3. Arthroscopic Microfracture Right LFC (29879)
4. Arthroscopic Right partial lateral meniscectomy (29881)
5. Arthroscopic shaving chondroplasty Right MFC (29877) Not coding this
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
100cc
IV FLUIDS:
800cc
INDICATIONS FOR PROCEDURE:
xxxxx is a 27 y.o. male with a history of right knee
injury 9 years ago. He had a noncontact pivoting injury
during a walkout tryout forxxxxxx for the
football team. He rehabbed and treated this nonoperatively.
He was able to lift weights, but cannot cut and pivot on his
right knee. He reports no pain, but does have
instability and mechanical symptoms. He has had no physical
therapy, injections or surgery to this point.
He had a history an physical exam consistent with an ACL tear and instability with mechanical symptoms of catching and locking. He had an MRI that showed an ACL tearwith Medial, Lateral meniscus tear. 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:
xxxxxx was brought to the operating room, placed supine on the OR
table and underwent general anesthesia without difficulty. Preop time-out
was done identifying his Right knee as the operative knee. He was givenpreoperative antibiotics and a block in the holding area. His examination under anesthesia revealed a grade III Lachman. He was stable to varus andstable valgus stress. He had a grade II anterior drawer and a stable posterior drawer , grade II pivot shift and a stable dial's test.
He was placed in nonsterile tourniquet and prepped and draped in sterile
fashion using ChloraPrep. his limb was elevated, exsanguinated and
tourniquet was raised. We first harvested his hamstring tendons through a 3
cm incision halfway between his tibial tubercle and posterior medial aspect
of his tibial plateau. We identified the sartorius fascia, elevated it in a
trapdoor fashion and harvested the gracilis and semitendinosus in standard
fashion. They were taken back to the backtable, where Nidhi Patel, PA,
prepared them to pass through an 8 mm graft and looped them over an Arthrex
ACL tightrope. The graft was tensioned appropriately. I was concomitantly
performing a diagnostic arthroscopy. Standard diagnostic arthroscopy was begun using
anteromedial and anterolateral portal 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 1 chondromalacia involving the trochlea. The medial joint had grade 3 chondromalacia on the medial femoral condyle that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and grade 2 chondromalacia on the medial tibial plateau. The meniscus was torn with a vertical tear at the lateral aspect of the posterior horn approx 2cm in length. This encompassed approximately 85% of the meniscal width and it was intact to probing after first rasping and then repairing it with three Mitek Omnispan devices. The intercondylar notch revealed an torn ACL with empty lateral wall sign and an intact PCL. The lateral joint had grade 4 chondromalacia on the lateral femoral condyle that was first prepared with a shaver and curette and then microfractures with 3 pilot holes and grade 2 chondromalacia on the lateral tibial plateau. The meniscus was torn with a small radial tear at the midbody. This encompassed approximately 25% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. A minimal notchplasty was performed in order to visualize the over-the-top position. I then drilled an 9 mm tunnel along the medial aspect of the ACL footprint, even with the anterior horn of lateral meniscus approximately 9 mm in front of the PCL with the retro cutter. We then placed
our flip cutter guide at the anatomic insertion on the femur and drilled
To 30 mm after measuring 40mm tunnel length. After measuring the tunnel length the femoral tunnel was reamed to the appropriate depth. We then passed our graft from distal to proximal and flipped our ACL tightrope. This gave us good fixation on the
femoral side. We then cycled through 15 flexion,
extension cycles, brought it out to full extension and used our tie
tensioner to tension all 4 limbs of the graft distally. We dilated the
tibial ACL tunnel and placed a Mitek Bio-Intrafix sheath and screw
with excellent capture of the graft distally. The graft was supplementary fixed with a swivel lock in the tibia. Intraoperative Lachman was
stable. We then copiously irrigated the wound and closed the sartorius
fascia in a trap door fashion using interrupted 0-Vicryl stitches in a
figure-of-eight fashion. All the portals were closed using interrupted 3-0
nylon stitches in a simple fashion. The ACL harvest incision was closed in
subcutaneous layer using 2-0 Vicryls and on the skin using a 3-0 Prolene in
a subcuticular fashion. Steri-Strips were placed over that wound, Xeroform
over the other wounds. Dressing sponges, ABD, Webril, Ace wrap were
applied. The patient was placed in a hinged knee brace from 0-90 degrees. The patient tolerated the procedure well and transferred to the recovery room in stable condition.
Postoperatively, He can be weightbearing as tolerated on his Right lower extremity and start physical therapy in 1-3 days on my ACL with meniscal repair rehabilitation protocol. We will see him back in clinic in 10-14 days for repeat evaluation and suture removal.
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Right anterior cruciate ligament tear medial and lateral meniscus tears. Chondromalacia MFC/LFC
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE:
1. Anatomic Right arthroscopic ACL reconstruction using an 8 mm femur/9mm tibia hamstring autograft.(29888)
2. Arthroscopic Right Medial meniscus repair (29882)
3. Arthroscopic Microfracture Right LFC (29879)
4. Arthroscopic Right partial lateral meniscectomy (29881)
5. Arthroscopic shaving chondroplasty Right MFC (29877) Not coding this
ANESTHESIA:
General with a block.
ESTIMATED BLOOD LOSS:
100cc
IV FLUIDS:
800cc
INDICATIONS FOR PROCEDURE:
xxxxx is a 27 y.o. male with a history of right knee
injury 9 years ago. He had a noncontact pivoting injury
during a walkout tryout forxxxxxx for the
football team. He rehabbed and treated this nonoperatively.
He was able to lift weights, but cannot cut and pivot on his
right knee. He reports no pain, but does have
instability and mechanical symptoms. He has had no physical
therapy, injections or surgery to this point.
He had a history an physical exam consistent with an ACL tear and instability with mechanical symptoms of catching and locking. He had an MRI that showed an ACL tearwith Medial, Lateral meniscus tear. 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:
xxxxxx was brought to the operating room, placed supine on the OR
table and underwent general anesthesia without difficulty. Preop time-out
was done identifying his Right knee as the operative knee. He was givenpreoperative antibiotics and a block in the holding area. His examination under anesthesia revealed a grade III Lachman. He was stable to varus andstable valgus stress. He had a grade II anterior drawer and a stable posterior drawer , grade II pivot shift and a stable dial's test.
He was placed in nonsterile tourniquet and prepped and draped in sterile
fashion using ChloraPrep. his limb was elevated, exsanguinated and
tourniquet was raised. We first harvested his hamstring tendons through a 3
cm incision halfway between his tibial tubercle and posterior medial aspect
of his tibial plateau. We identified the sartorius fascia, elevated it in a
trapdoor fashion and harvested the gracilis and semitendinosus in standard
fashion. They were taken back to the backtable, where Nidhi Patel, PA,
prepared them to pass through an 8 mm graft and looped them over an Arthrex
ACL tightrope. The graft was tensioned appropriately. I was concomitantly
performing a diagnostic arthroscopy. Standard diagnostic arthroscopy was begun using
anteromedial and anterolateral portal 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 1 chondromalacia involving the trochlea. The medial joint had grade 3 chondromalacia on the medial femoral condyle that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and grade 2 chondromalacia on the medial tibial plateau. The meniscus was torn with a vertical tear at the lateral aspect of the posterior horn approx 2cm in length. This encompassed approximately 85% of the meniscal width and it was intact to probing after first rasping and then repairing it with three Mitek Omnispan devices. The intercondylar notch revealed an torn ACL with empty lateral wall sign and an intact PCL. The lateral joint had grade 4 chondromalacia on the lateral femoral condyle that was first prepared with a shaver and curette and then microfractures with 3 pilot holes and grade 2 chondromalacia on the lateral tibial plateau. The meniscus was torn with a small radial tear at the midbody. This encompassed approximately 25% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. A minimal notchplasty was performed in order to visualize the over-the-top position. I then drilled an 9 mm tunnel along the medial aspect of the ACL footprint, even with the anterior horn of lateral meniscus approximately 9 mm in front of the PCL with the retro cutter. We then placed
our flip cutter guide at the anatomic insertion on the femur and drilled
To 30 mm after measuring 40mm tunnel length. After measuring the tunnel length the femoral tunnel was reamed to the appropriate depth. We then passed our graft from distal to proximal and flipped our ACL tightrope. This gave us good fixation on the
femoral side. We then cycled through 15 flexion,
extension cycles, brought it out to full extension and used our tie
tensioner to tension all 4 limbs of the graft distally. We dilated the
tibial ACL tunnel and placed a Mitek Bio-Intrafix sheath and screw
with excellent capture of the graft distally. The graft was supplementary fixed with a swivel lock in the tibia. Intraoperative Lachman was
stable. We then copiously irrigated the wound and closed the sartorius
fascia in a trap door fashion using interrupted 0-Vicryl stitches in a
figure-of-eight fashion. All the portals were closed using interrupted 3-0
nylon stitches in a simple fashion. The ACL harvest incision was closed in
subcutaneous layer using 2-0 Vicryls and on the skin using a 3-0 Prolene in
a subcuticular fashion. Steri-Strips were placed over that wound, Xeroform
over the other wounds. Dressing sponges, ABD, Webril, Ace wrap were
applied. The patient was placed in a hinged knee brace from 0-90 degrees. The patient tolerated the procedure well and transferred to the recovery room in stable condition.
Postoperatively, He can be weightbearing as tolerated on his Right lower extremity and start physical therapy in 1-3 days on my ACL with meniscal repair rehabilitation protocol. We will see him back in clinic in 10-14 days for repeat evaluation and suture removal.
