Has anyone had a case like this:
The proposed codes my provider wants me to bill on the following case:
1. 29838 Arthroscopy, elbow, surgical; debridement, extensive
2. 24102 Arthrotomy, elbow; with synovectomy
3. 24110 Excision or curettage of bone cyst or benign tumor, humerus;
4. 24999 – for the open drilling, with 29879 as the referring code.
I am thinking with this case, I can only bill 24999 (with the 29879 as referring code), and 24102. Seems like the lesions addressed would be covered under the 24999. I am not comfortable billing the 29838 and the 24110. Seems like that would be included in the other two. Here is the note:
Procedures performed:
DX: Right Elbow unstable OCD (osteochondritis dissecans) lesion, with synovitis and surrounding chondrosis
1. Surgical elbow arthroscopy, extensive debridement including chondroplasty and loose cartilage pieces removal.
2. Open elbow arthrotomy with synovectomy, and open excision of the benign bone lesion with abrasion and microfracture, drilling
Elbow Arthroscopy:
The anteromedial portal was created proximally and anteriorly to the medial epicondyle through the biceps-triceps intermuscular septum, after skin incision was made. arthrscope was introduced to the anterior joint space after careful dissection for the path.
The anterolateral portal trajectory was confirmed under direct arthroscopic visualization using a spinal needle entering from a spot proximal and anterior to the lateral epicondyle. Long switching stick was utilized to created the portal after the incision was made. Diagnostic arthroscopy was done and necessary work was done as summarized below.
The soft-spot portal was created and small joint arthroscope was introduced to the posterolateral joint space; lateral accessory portal was established, lateral to the soft spot portal, under direct visualization by using the spinal needle as guidance. Diagnostic arthroscopy was done and necessary work was done, as summarized below. .
The findings were:
1. Radio-capitellum joint: radial head grade I-II chondrosis, in here, multiple loose flying cartilage pieces; anteriorly and posteriorly, synovitis
2. Trochlea-Olecranon joint: mild chondrosis
3. Synovitis: anteriorly and posteriorly in both radio-capitellum joint and the trochlea-olecranon joint
4. loose body: flying multiple cartilage pieces
5. Benign bone lesion, compatible with unstable OCD lesion, measures 10 mm in A-P axis and 6-7 mm in the Lat-Med diameter, in the medial side of the capitellum joint surface.
The loose pieces were removed successfully and chondroplasty was performed extensively at the compartments mentioned above.
The arthroscope was retreived from the joint.
Open Elbow Surgery:
An open incision was made by extending the posterolateral soft spot portal, in a longitudinal way. The anconeus was split and the exposed joint capsule was incised open. The radio-capitellar joint was brought into direct eyesight. By hyperflexing the elbow, we were able to directly visualize the osteochondral lesion on the capitellum.
We first performed synovectomy to resect the inflammatory synovium surrounding this area.
We then used a biter and small scissors and the shaver, through this open incision, to resect the osteochondral lesion until we were sure that the cartilage and the subchondral bone at the border of this lesion was stable. After resection of the lesion, this led us to an shallow but broad osteochondral defect about 10 mm (anterior-posterior) x 6-7 mm (medial-lateral) in the medial side of the capitellum joint surface.
We curettaged this area using high-speed mode of the shaver and the metal suction tip. We used 1.4 mm K-wires to perform multiple drilling for bone marrow stimulation a bed here.
The proposed codes my provider wants me to bill on the following case:
1. 29838 Arthroscopy, elbow, surgical; debridement, extensive
2. 24102 Arthrotomy, elbow; with synovectomy
3. 24110 Excision or curettage of bone cyst or benign tumor, humerus;
4. 24999 – for the open drilling, with 29879 as the referring code.
I am thinking with this case, I can only bill 24999 (with the 29879 as referring code), and 24102. Seems like the lesions addressed would be covered under the 24999. I am not comfortable billing the 29838 and the 24110. Seems like that would be included in the other two. Here is the note:
Procedures performed:
DX: Right Elbow unstable OCD (osteochondritis dissecans) lesion, with synovitis and surrounding chondrosis
1. Surgical elbow arthroscopy, extensive debridement including chondroplasty and loose cartilage pieces removal.
2. Open elbow arthrotomy with synovectomy, and open excision of the benign bone lesion with abrasion and microfracture, drilling
Elbow Arthroscopy:
The anteromedial portal was created proximally and anteriorly to the medial epicondyle through the biceps-triceps intermuscular septum, after skin incision was made. arthrscope was introduced to the anterior joint space after careful dissection for the path.
The anterolateral portal trajectory was confirmed under direct arthroscopic visualization using a spinal needle entering from a spot proximal and anterior to the lateral epicondyle. Long switching stick was utilized to created the portal after the incision was made. Diagnostic arthroscopy was done and necessary work was done as summarized below.
The soft-spot portal was created and small joint arthroscope was introduced to the posterolateral joint space; lateral accessory portal was established, lateral to the soft spot portal, under direct visualization by using the spinal needle as guidance. Diagnostic arthroscopy was done and necessary work was done, as summarized below. .
The findings were:
1. Radio-capitellum joint: radial head grade I-II chondrosis, in here, multiple loose flying cartilage pieces; anteriorly and posteriorly, synovitis
2. Trochlea-Olecranon joint: mild chondrosis
3. Synovitis: anteriorly and posteriorly in both radio-capitellum joint and the trochlea-olecranon joint
4. loose body: flying multiple cartilage pieces
5. Benign bone lesion, compatible with unstable OCD lesion, measures 10 mm in A-P axis and 6-7 mm in the Lat-Med diameter, in the medial side of the capitellum joint surface.
The loose pieces were removed successfully and chondroplasty was performed extensively at the compartments mentioned above.
The arthroscope was retreived from the joint.
Open Elbow Surgery:
An open incision was made by extending the posterolateral soft spot portal, in a longitudinal way. The anconeus was split and the exposed joint capsule was incised open. The radio-capitellar joint was brought into direct eyesight. By hyperflexing the elbow, we were able to directly visualize the osteochondral lesion on the capitellum.
We first performed synovectomy to resect the inflammatory synovium surrounding this area.
We then used a biter and small scissors and the shaver, through this open incision, to resect the osteochondral lesion until we were sure that the cartilage and the subchondral bone at the border of this lesion was stable. After resection of the lesion, this led us to an shallow but broad osteochondral defect about 10 mm (anterior-posterior) x 6-7 mm (medial-lateral) in the medial side of the capitellum joint surface.
We curettaged this area using high-speed mode of the shaver and the metal suction tip. We used 1.4 mm K-wires to perform multiple drilling for bone marrow stimulation a bed here.