I Bill for an ASC and we outsource our coding locally. The coding co. coded this op report w/ 29880-LT& 29875-59-LT. This is a workers' Comp. claim and they only paid for the 29880-LT. I asked the coder why they coded 29875-59-LT, they stated "There are 3 compartments in the knee, the patellar, medial and lateral. The patellar compartment is comprised the patellar pouches, as well as the medial and lateral gutters. In this case, the synovectomy was performed in the superior pouch, as well as both gutters". Is this correct? can someone help me word this so I can send in for a 2nd level appeal?
POSTOPERATIVE DIAGNOSES:
1.Medial meniscal tear, left knee.
2.Lateral meniscal tear, left knee.
3.Early arthritis, left knee.
4.Effusion, left knee.
5.Synovitis, left knee.
PROCEDURE PERFORMED:
1.Arthroscopic partial medial meniscectomy, left knee.
2.Arthroscopic partial lateral meniscectomy, left knee.
3.Arthroscopic partial synovectomy, left knee.
INDICATIONS:
The patient is a 56-year-old male who injured his left knee at work on 09/21/11. Workup suggests a meniscal tear, with some early arthritis of the knee. He has experienced persistent effusions and synovitis. He now wishes to undergo arthroscopy.
OPERATIVE PROCEDURE IN DETAIL:
The patient was brought into the Operating Suite and placed supine on the operating room table. After obtaining adequate general anesthesia, the left knee was examined and was found to be stable in all directions. The left leg was prepped and draped in the usual sterile manner. The portal sites were pre-injected with 0.25% Marcaine with epinephrine.
Inferomedial and inferolateral portals were established. The arthroscope was initially brought in through the inferolateral portal. There was a moderate effusion and fluid was removed. There was diffuse synovitis in the superior pouch and the medial and lateral gutters. Partial synovectomy was performed. There was chondromalacia of the patella and in the trochlear groove, which appeared to be chronic and stable. There were Grade II and Grade III changes in the patella, mostly softening of the trochlea. The medial compartment was entered. There was a complex meniscal tear. There was a flap component which had flipped into the notch and was still attached to the meniscal root centrally. This was resected. In addition, there was a complex tear involving the mid-horn and the posterior horn of the medial meniscus, with tears in multiple planes. About 70-80% of the posterior horn required removal. The mid-horn was tapered into the posterior horn for a smooth transition. There was some early arthritis of the femoral condyle and the tibial plateau; nothing down to bone; mostly near the notch where the meniscal fragment was impinging. The notch was entered. The cruciate ligaments were normal. The lateral compartment was entered. There was a complex lateral meniscal tear along the inner rim. Partial meniscectomy was performed. Only about 10% of the meniscus required removal. There was no significant arthritis laterally. At this point, the knee was copiously irrigated.
The portals were closed utilizing 4-0 Monocryl suture followed by Steri-Strips. Dressings were applied. The patient was then awakened and taken to Recovery in stable condition.
Estimated Blood Loss - Minimal. Complications - None. Sponge and needle counts correct.
POSTOPERATIVE DIAGNOSES:
1.Medial meniscal tear, left knee.
2.Lateral meniscal tear, left knee.
3.Early arthritis, left knee.
4.Effusion, left knee.
5.Synovitis, left knee.
PROCEDURE PERFORMED:
1.Arthroscopic partial medial meniscectomy, left knee.
2.Arthroscopic partial lateral meniscectomy, left knee.
3.Arthroscopic partial synovectomy, left knee.
INDICATIONS:
The patient is a 56-year-old male who injured his left knee at work on 09/21/11. Workup suggests a meniscal tear, with some early arthritis of the knee. He has experienced persistent effusions and synovitis. He now wishes to undergo arthroscopy.
OPERATIVE PROCEDURE IN DETAIL:
The patient was brought into the Operating Suite and placed supine on the operating room table. After obtaining adequate general anesthesia, the left knee was examined and was found to be stable in all directions. The left leg was prepped and draped in the usual sterile manner. The portal sites were pre-injected with 0.25% Marcaine with epinephrine.
Inferomedial and inferolateral portals were established. The arthroscope was initially brought in through the inferolateral portal. There was a moderate effusion and fluid was removed. There was diffuse synovitis in the superior pouch and the medial and lateral gutters. Partial synovectomy was performed. There was chondromalacia of the patella and in the trochlear groove, which appeared to be chronic and stable. There were Grade II and Grade III changes in the patella, mostly softening of the trochlea. The medial compartment was entered. There was a complex meniscal tear. There was a flap component which had flipped into the notch and was still attached to the meniscal root centrally. This was resected. In addition, there was a complex tear involving the mid-horn and the posterior horn of the medial meniscus, with tears in multiple planes. About 70-80% of the posterior horn required removal. The mid-horn was tapered into the posterior horn for a smooth transition. There was some early arthritis of the femoral condyle and the tibial plateau; nothing down to bone; mostly near the notch where the meniscal fragment was impinging. The notch was entered. The cruciate ligaments were normal. The lateral compartment was entered. There was a complex lateral meniscal tear along the inner rim. Partial meniscectomy was performed. Only about 10% of the meniscus required removal. There was no significant arthritis laterally. At this point, the knee was copiously irrigated.
The portals were closed utilizing 4-0 Monocryl suture followed by Steri-Strips. Dressings were applied. The patient was then awakened and taken to Recovery in stable condition.
Estimated Blood Loss - Minimal. Complications - None. Sponge and needle counts correct.