asight0383
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Need help with CPT coding for a surgery my physician did...
Postoperative Diagnosis: Displaced chondral condylar fracture, lateral right knee, with displacement.
Operative Procedure: Arthoscopy followed by arthrotomy with chondral condylar repair with Arthrex bioabsorbable darts x 5
Technique: Following induction of general anesthetic, the patient's right lower extemity was prepped and draped in standard fashion. Surgical timeout was employed. All parties were in agreement. Anteromedial arthoscopic portal was employed, and visualization of the knee once entering in through same, demonstrated residual hemarthrosis which was flushed and demonstrated large displaced chondral fragment from the lateral femoral condyle. It was noted it would not be possible to fixate same adequately well through arthoscopic portal alone as was previously discussed with the patient and family. Arthoscope was withdrawn. Leg was exsanquinated with an Esmarch. Proximal thigh tourniquet elevated to 300 mmHg. Straight anteolaterl arthrotomy incision was made extending from the inferior pole of the patella towards the tibial tubercle just lateral to midline. Dissection of skin and subcatnteous tissue was made. A lateral parpatellar arthrotomy was made splitting through the retrpoatellar fat pad which was minimally debulked. Upon entering the knee joint, the displaced condylar cartilage fragment was removed. Photographs were taken and demonstrated approxmiate diamter to be 1 inch and nearly semicircular or spherical. The defect itself was down to the subchondral bone. There were no bone attachments to the chondral fragment alone. Deep retractors were inserted. The knee was irrigated. Minimal residual cartilage, fibrinous material overlying the defect site was cleansed, and with care, the displaced fragment was placed back into the knee, alighed, seen to have good residual peripheral alighment in place. Using Arthrex bioabsorbable darts, this was fixated back in place with prior 2 small K-wires for provisional fixation to ain in the application of the internal fixation applied, x5 in more of a peripheral star pattern was employed. The darts were maintained at the edge of the articular surface flush to same without roughened edges extending distally. Photographs were taken intermittently throughout the operative procedure. The previous arthroscopy demonstrated intercondylar notch area of the ACL to be intact, the medial femoral condyle and medial meniscus intact. The laterl meniscus was intact. Lateral tibial plateau and patellofemoral mechnism were intact. Final irrigation was employed with photos of the chondral fragment back into is condylar base with the anchorage made. The knee was irrigated of final saline. The arthrotomy was repaired with 2-0 Vicryl interrupted sutures, subcuctaneous with 3-0 Vicryl, and the skin with 3-0 Prolene subcuticular closer. The surgical site was locally infilitrated with 1% lidocaine. Sterile dressing applied with Steri-Strips. Tourniquet was released with compressive wrap applied. The patient tolerated the proced well, was then extubated and transferred to the recovery room where at T-Scope controlled range of motion brace was applied locked at roughly 45 degrees.
Any help would be greatly appreciated!
Postoperative Diagnosis: Displaced chondral condylar fracture, lateral right knee, with displacement.
Operative Procedure: Arthoscopy followed by arthrotomy with chondral condylar repair with Arthrex bioabsorbable darts x 5
Technique: Following induction of general anesthetic, the patient's right lower extemity was prepped and draped in standard fashion. Surgical timeout was employed. All parties were in agreement. Anteromedial arthoscopic portal was employed, and visualization of the knee once entering in through same, demonstrated residual hemarthrosis which was flushed and demonstrated large displaced chondral fragment from the lateral femoral condyle. It was noted it would not be possible to fixate same adequately well through arthoscopic portal alone as was previously discussed with the patient and family. Arthoscope was withdrawn. Leg was exsanquinated with an Esmarch. Proximal thigh tourniquet elevated to 300 mmHg. Straight anteolaterl arthrotomy incision was made extending from the inferior pole of the patella towards the tibial tubercle just lateral to midline. Dissection of skin and subcatnteous tissue was made. A lateral parpatellar arthrotomy was made splitting through the retrpoatellar fat pad which was minimally debulked. Upon entering the knee joint, the displaced condylar cartilage fragment was removed. Photographs were taken and demonstrated approxmiate diamter to be 1 inch and nearly semicircular or spherical. The defect itself was down to the subchondral bone. There were no bone attachments to the chondral fragment alone. Deep retractors were inserted. The knee was irrigated. Minimal residual cartilage, fibrinous material overlying the defect site was cleansed, and with care, the displaced fragment was placed back into the knee, alighed, seen to have good residual peripheral alighment in place. Using Arthrex bioabsorbable darts, this was fixated back in place with prior 2 small K-wires for provisional fixation to ain in the application of the internal fixation applied, x5 in more of a peripheral star pattern was employed. The darts were maintained at the edge of the articular surface flush to same without roughened edges extending distally. Photographs were taken intermittently throughout the operative procedure. The previous arthroscopy demonstrated intercondylar notch area of the ACL to be intact, the medial femoral condyle and medial meniscus intact. The laterl meniscus was intact. Lateral tibial plateau and patellofemoral mechnism were intact. Final irrigation was employed with photos of the chondral fragment back into is condylar base with the anchorage made. The knee was irrigated of final saline. The arthrotomy was repaired with 2-0 Vicryl interrupted sutures, subcuctaneous with 3-0 Vicryl, and the skin with 3-0 Prolene subcuticular closer. The surgical site was locally infilitrated with 1% lidocaine. Sterile dressing applied with Steri-Strips. Tourniquet was released with compressive wrap applied. The patient tolerated the proced well, was then extubated and transferred to the recovery room where at T-Scope controlled range of motion brace was applied locked at roughly 45 degrees.
Any help would be greatly appreciated!