RebeccaWoodward*
True Blue
Please provide your opinion on this op note……
PREOPERATIVE DIAGNOSIS: Right knee pain secondary to medial and lateral meniscal tears.
POSTOPERATIVE DIAGNOSES: Right knee pain secondary to medial and lateral meniscal tears; chondromalacia involving the medial and lateral femoral condyles and patellofemoral joint; inflamed plica and fat pad.
PROCEDURES: Arthroscopy of right knee with partial medial and lateral meniscectomies; abrasion chondroplasties medial and lateral femoral condyles; wide debridement of inflamed plica and fat pad.
Inflow cannula was introduced through a superomedial portal, and the irrigant contained epinephrine per protocol. The arthroscope was introduced through an anterolateral portal, and the knee was scanned with the following findings:
1. Suprapatellar pouch normal.
2. Patellofemoral joint demonstrated grade 2/3 chondromalacia changes on the patellar side and grade 3 changes on the femoral trochlea. There was an inflamed plica and fat pad, which was impinging into the patellofemoral joint.
3. Medial compartment showed grade 3 chondromalacia changes on the majority of the medial femoral condyle, with thinning of the medial tibial articular cartilage. There was a tear of the medial meniscus extending from the junction of the middle and posterior thirds posteriorly. There was also inflamed synovium and fat pad that was clearly impinging into the medial compartment.
4. The intercondylar notch showed an inflamed ligamentum mucosum and fat pad. The anterior and posterior cruciate ligaments were intact. There was some osteophytic narrowing of the intracondylar notch.
5. Lateral compartment showed grade 3 chondromalacia changes on a large part of the lateral femoral condyle. There was undersurface tearing of the lateral meniscus in the posterior horn, as well as tearing of the anterior horn.
A probe was introduced through an anteromedial portal, and the extent of the medial and lateral meniscal tears were defined by probing and partial meniscectomies performed back to a stable rim on each side using combination of punch, shaver, and electrocautery. The undermined articular cartilage on the medial and lateral femoral condyles was then smoothed with abrasion chondroplasty technique. I then performed a wide debridement of the inflamed plica and fat pads such that at the end of the debridement there was no further ability of any of these tissues to impinge into any of the 3 compartments of the knee.
Charges were originally entered as 29879 & 29881
Here’s what I think is correct……..29880 (since a medial AND lateral meniscectomy was performed)
29875 since a debridement of the inflamed plica was performed in the Patellofemoral compartment.
NO 29879 since the chondroplasties took place in the same compartments as the meniscectomies.
Since I completley disagree with original coding, I'm double checking. Now...I could be wrong and overlooking something...that's why I need your opinions...
PREOPERATIVE DIAGNOSIS: Right knee pain secondary to medial and lateral meniscal tears.
POSTOPERATIVE DIAGNOSES: Right knee pain secondary to medial and lateral meniscal tears; chondromalacia involving the medial and lateral femoral condyles and patellofemoral joint; inflamed plica and fat pad.
PROCEDURES: Arthroscopy of right knee with partial medial and lateral meniscectomies; abrasion chondroplasties medial and lateral femoral condyles; wide debridement of inflamed plica and fat pad.
Inflow cannula was introduced through a superomedial portal, and the irrigant contained epinephrine per protocol. The arthroscope was introduced through an anterolateral portal, and the knee was scanned with the following findings:
1. Suprapatellar pouch normal.
2. Patellofemoral joint demonstrated grade 2/3 chondromalacia changes on the patellar side and grade 3 changes on the femoral trochlea. There was an inflamed plica and fat pad, which was impinging into the patellofemoral joint.
3. Medial compartment showed grade 3 chondromalacia changes on the majority of the medial femoral condyle, with thinning of the medial tibial articular cartilage. There was a tear of the medial meniscus extending from the junction of the middle and posterior thirds posteriorly. There was also inflamed synovium and fat pad that was clearly impinging into the medial compartment.
4. The intercondylar notch showed an inflamed ligamentum mucosum and fat pad. The anterior and posterior cruciate ligaments were intact. There was some osteophytic narrowing of the intracondylar notch.
5. Lateral compartment showed grade 3 chondromalacia changes on a large part of the lateral femoral condyle. There was undersurface tearing of the lateral meniscus in the posterior horn, as well as tearing of the anterior horn.
A probe was introduced through an anteromedial portal, and the extent of the medial and lateral meniscal tears were defined by probing and partial meniscectomies performed back to a stable rim on each side using combination of punch, shaver, and electrocautery. The undermined articular cartilage on the medial and lateral femoral condyles was then smoothed with abrasion chondroplasty technique. I then performed a wide debridement of the inflamed plica and fat pads such that at the end of the debridement there was no further ability of any of these tissues to impinge into any of the 3 compartments of the knee.
Charges were originally entered as 29879 & 29881
Here’s what I think is correct……..29880 (since a medial AND lateral meniscectomy was performed)
29875 since a debridement of the inflamed plica was performed in the Patellofemoral compartment.
NO 29879 since the chondroplasties took place in the same compartments as the meniscectomies.
Since I completley disagree with original coding, I'm double checking. Now...I could be wrong and overlooking something...that's why I need your opinions...
