l1ttle_0ne
Guru
I'm new to ortho coding and this is confusing me. Would this be 29884 and 29876? Or possibly 27570 for the manipulation instead of 29884 since it says the arthroscopic equipment has been Removed?
PREOPERATIVE DIAGNOSIS: Right knee arthrofibrosis status post total knee arthroplasty.
POSTOPERATIVE DIAGNOSIS: Right knee arthrofibrosis status post total knee arthroplasty.
OPERATION: Right knee arthroscopy with debridement, adhesiolysis, and manipulation.
INDICATIONS: The patient is a male with persistent right knee stiffness status post total knee
arthroplasty. Despite therapy and manipulation, he has persistent stiffness and wishes to proceed with
arthroscopic debridement and adhesiolysis with manipulation.
PROCEDURE IN DETAIL: The patient was anesthetized with uncomplicated general laryngeal mask
anesthesia. An adductor canal block was performed. He was positioned supine on the operating
table where he was carefully padded and stabilized. An SCD was fit on the left leg to be used intra- and
postoperatively. He was given 2 g of IV Ancef within 1 hour of incision, which will be discontinued
postoperatively. He was given 1 g of IV tranexamic acid immediately prior to surgery. Right knee examination
showed 10 to 86 degrees of motion. The right lower extremity was prepped and draped in the usual sterile
manner. After elevation and with the knee flexed, a thigh tourniquet was inflated to 300 mmHg and left inflated
for a total of 61 minutes.
Arthroscopic portals were infiltrated with 0.25% Marcaine with epinephrine. Anterolateral and superomedial
portals were created with a #11 blade and the arthroscopic equipment inserted in the usual careful manner.
Great care was taken to protect the implants throughout the case. After needle localization, an anteromedial
portal was created. The knee was methodically examined with the findings noted in a separate paragraph
below. Carefully now, using a motorized shaver, the soft tissues in the infrapatellar recess and the anterior
compartment were debrided. Sequentially, the medial gutter, suprapatellar pouch, and then lateral gutter were
debrided, removing all adhesions and contracted tissue. The lateral gutter was debrided with the arthroscope
in the superomedial portal. Examination showed the patella to track well with range of motion. There was no
evidence of implant failure or loosening. The arthroscopic equipment was removed. The knee was now
manipulated, achieving 4 degrees of extension and 105 degrees of flexion. Further manipulation was deemed
unwise. Please note that the posterior cruciate ligament was carefully examined arthroscopically and noted to
be without undue contracture. Thus, release was not deemed necessary. The notch was debrided of soft
tissue. The wounds were now reapproximated with a subcutaneous 4-0 Vicryl suture and the skin Steri-
Stripped. The tourniquet was deflated. The wound sterilely dressed. The extremity was wrapped with a toes
to thigh Ace wrap. The patient was awakened and taken to the recovery room in stable condition, having
tolerated the procedure well. There were no complications. Blood loss was estimated at 10 mL. No pathology
was sent.
FINDINGS: Arthroscopic examination of the right knee revealed adhesions in the suprapatellar pouch, medial
and lateral gutters. The patella showed grade 2 chondromalacia that was otherwise intact. The quadriceps
tendon was intact throughout the case. The notch revealed minimal soft tissue hypertrophy. There was mild to
moderate hypertrophy of the soft tissues in the anterior aspect of the medial and lateral compartments in the
infrapatellar space. The articular surfaces of the femoral component and polyethylene were smooth and intact.
The posterior cruciate ligament was intact without contracture.
PREOPERATIVE DIAGNOSIS: Right knee arthrofibrosis status post total knee arthroplasty.
POSTOPERATIVE DIAGNOSIS: Right knee arthrofibrosis status post total knee arthroplasty.
OPERATION: Right knee arthroscopy with debridement, adhesiolysis, and manipulation.
INDICATIONS: The patient is a male with persistent right knee stiffness status post total knee
arthroplasty. Despite therapy and manipulation, he has persistent stiffness and wishes to proceed with
arthroscopic debridement and adhesiolysis with manipulation.
PROCEDURE IN DETAIL: The patient was anesthetized with uncomplicated general laryngeal mask
anesthesia. An adductor canal block was performed. He was positioned supine on the operating
table where he was carefully padded and stabilized. An SCD was fit on the left leg to be used intra- and
postoperatively. He was given 2 g of IV Ancef within 1 hour of incision, which will be discontinued
postoperatively. He was given 1 g of IV tranexamic acid immediately prior to surgery. Right knee examination
showed 10 to 86 degrees of motion. The right lower extremity was prepped and draped in the usual sterile
manner. After elevation and with the knee flexed, a thigh tourniquet was inflated to 300 mmHg and left inflated
for a total of 61 minutes.
Arthroscopic portals were infiltrated with 0.25% Marcaine with epinephrine. Anterolateral and superomedial
portals were created with a #11 blade and the arthroscopic equipment inserted in the usual careful manner.
Great care was taken to protect the implants throughout the case. After needle localization, an anteromedial
portal was created. The knee was methodically examined with the findings noted in a separate paragraph
below. Carefully now, using a motorized shaver, the soft tissues in the infrapatellar recess and the anterior
compartment were debrided. Sequentially, the medial gutter, suprapatellar pouch, and then lateral gutter were
debrided, removing all adhesions and contracted tissue. The lateral gutter was debrided with the arthroscope
in the superomedial portal. Examination showed the patella to track well with range of motion. There was no
evidence of implant failure or loosening. The arthroscopic equipment was removed. The knee was now
manipulated, achieving 4 degrees of extension and 105 degrees of flexion. Further manipulation was deemed
unwise. Please note that the posterior cruciate ligament was carefully examined arthroscopically and noted to
be without undue contracture. Thus, release was not deemed necessary. The notch was debrided of soft
tissue. The wounds were now reapproximated with a subcutaneous 4-0 Vicryl suture and the skin Steri-
Stripped. The tourniquet was deflated. The wound sterilely dressed. The extremity was wrapped with a toes
to thigh Ace wrap. The patient was awakened and taken to the recovery room in stable condition, having
tolerated the procedure well. There were no complications. Blood loss was estimated at 10 mL. No pathology
was sent.
FINDINGS: Arthroscopic examination of the right knee revealed adhesions in the suprapatellar pouch, medial
and lateral gutters. The patella showed grade 2 chondromalacia that was otherwise intact. The quadriceps
tendon was intact throughout the case. The notch revealed minimal soft tissue hypertrophy. There was mild to
moderate hypertrophy of the soft tissues in the anterior aspect of the medial and lateral compartments in the
infrapatellar space. The articular surfaces of the femoral component and polyethylene were smooth and intact.
The posterior cruciate ligament was intact without contracture.
