The physician’s office is stating CPT 29898 and 27641. I code for an ASC and I am looking at codes 29891 & 29898 or only 29898. I do not see where an incision was made to convert to an open procedure and also I believe that if open the correct code would be 27635. I appreciate any guidance you may offer, I do not have access to CPT assistant, AAOS… ect
POSTOPERATIVE DIAGNOSES: 1. Left ankle synovitis. 2. Left distal tibial exostosis.
OPERATIONS PERFORMED: 1. Left ankle arthroscopy with extensive debridement. 2. Left distal tibial exostectomy.
The patient had the left lower extremity marked. Appropriate consent was obtained. The patient was then transferred to the operating room and placed in the supine position on the operating table, sedated, and intubated perf anesthesia. The left lower extremity was placed in a leg holder and then prepped and draped in a sterile fashion. Timeout was taken. Proper identity, extremity, and procedure were confirmed. The tourniquet was inflated. The joint was inflated with 10 mL of sterile saline. Two small portal incisions were created along the anterior aspect of the ankle joint. The cannula and blunt trocar were placed into the medial joint. The camera was then introduced and used to inspect the anterior joint. There was found to be a large collection of fibrous tissue and synovitic tissue extending across the anterior aspect of the ankle joint. There was also noted to be a large anterior distal tibial exostosis. A shaver was introduced through a lateral portal site and used to debride the large collection of fibrous and synovitic tissue from the anterior joint and off the anterior tibial plafond exostosis. The camera was then placed through the lateral portal and a shaver was placed through the medial portal and used to debride the soft tissue and synovitic tissue from the medial gutter and along the medial side of the ankle joint line. Once all the synovitic fibrous tissue had been fully debrided from the anterior portion of the joint as well as the medial and lateral gutters, a bur was placed into the joint and used to resect the anterior distal tibial plafond exostosis. Once the bone had been fully resected, so there was no further anterior impingement. The camera and shaver were removed from the joint spaces. The portal sites were closed with 3-0 nylon suture in an interrupted fashion. Local anesthetic was applied around the incision with 0.5% Marcaine plain. The incisions were then covered with Xeroform dressing, 4x4's gauze, cast padding, and a short-leg plaster splint. The tourniquet was then released. The patient was then awakened, extubated, and transferred to Recovery in stable condition. At the end of the case, all needle, sponge and instrument counts were correct.
POSTOPERATIVE DIAGNOSES: 1. Left ankle synovitis. 2. Left distal tibial exostosis.
OPERATIONS PERFORMED: 1. Left ankle arthroscopy with extensive debridement. 2. Left distal tibial exostectomy.
The patient had the left lower extremity marked. Appropriate consent was obtained. The patient was then transferred to the operating room and placed in the supine position on the operating table, sedated, and intubated perf anesthesia. The left lower extremity was placed in a leg holder and then prepped and draped in a sterile fashion. Timeout was taken. Proper identity, extremity, and procedure were confirmed. The tourniquet was inflated. The joint was inflated with 10 mL of sterile saline. Two small portal incisions were created along the anterior aspect of the ankle joint. The cannula and blunt trocar were placed into the medial joint. The camera was then introduced and used to inspect the anterior joint. There was found to be a large collection of fibrous tissue and synovitic tissue extending across the anterior aspect of the ankle joint. There was also noted to be a large anterior distal tibial exostosis. A shaver was introduced through a lateral portal site and used to debride the large collection of fibrous and synovitic tissue from the anterior joint and off the anterior tibial plafond exostosis. The camera was then placed through the lateral portal and a shaver was placed through the medial portal and used to debride the soft tissue and synovitic tissue from the medial gutter and along the medial side of the ankle joint line. Once all the synovitic fibrous tissue had been fully debrided from the anterior portion of the joint as well as the medial and lateral gutters, a bur was placed into the joint and used to resect the anterior distal tibial plafond exostosis. Once the bone had been fully resected, so there was no further anterior impingement. The camera and shaver were removed from the joint spaces. The portal sites were closed with 3-0 nylon suture in an interrupted fashion. Local anesthetic was applied around the incision with 0.5% Marcaine plain. The incisions were then covered with Xeroform dressing, 4x4's gauze, cast padding, and a short-leg plaster splint. The tourniquet was then released. The patient was then awakened, extubated, and transferred to Recovery in stable condition. At the end of the case, all needle, sponge and instrument counts were correct.