jdibble
True Blue
Doctor did Arthroscopic Femoroplasty and a capsular reconstruction of the hip. I have 29914 for the femoroplasty but I am at a loss for the Capsular reconstruction. Any ideas on how to code this? And if 29999 would be the code, what code would you compare it to for pricing? Procedure is documented as follows:
The hip was then sterilely prepped followed by draping with a barrier drape centered over the anticipated surgical site. Fluoroscopy was then positioned and distraction of the hip joint was achieved with fine traction applied to the Hana table. Time in traction was noted and monitored throughout the case.
The surgical incisions were planned out. An anterior lateral portal was established 1st. A spinal needle was inserted just anterior and proximal to the tip of the greater trochanter and advanced into the hip joint under fluoroscopic guidance. A Nitinol wire was then placed into the joint with removal of the spinal needle a longitudinal incision was made at the wire entry site. Portal was dilated to the hip joint and a 4.5 mm cannula was inserted followed by the arthroscope. A mid anterior portal was then established in a similar fashion with spinal needle localization under direct arthroscopic visualization. A 5.5 mm cannula was then inserted over the Nitinol wire and the arthroscope was moved to the mid anterior portal for evaluation of the placement of anterior lateral portal to ensure no penetration of the labrum. The arthroscope was then moved back to the anterior lateral portal and diagnostic arthroscopy was then performed with the above findings.
Large area capsular deficiency was identified. In addition there was some remaining CAM lesion bone at the femoral head neck junction identified as a possible impinging structure and therefore revision of the femoroplasty was performed to complete the CAM resection, this was performed with a round bur. Decision was made to perform capsule reconstruction. Two additional portals were then established with spinal needle localization both the distal anterior lateral accessory portal and a proximal mid anterior portal. Trim it cannula was then measured and positioned through the anterior lateral portal. Tissue over the acetabular rim was debrided taking care to preserve the previous labral repair which showed no significant abnormalities. A bur was used to decorticate bone at the footprint of where the graft would sit. The medial edge of the capsule showed retained suture from previous attempted repair. The superior and inferior aspects of the capsulectomy were identified in tissue debrided around the margins of the capsule. Each limb of the remaining capsule was attempted to be reapproximated with no ability to approximate the capsular tissue. Debridement was then performed to the trochanteric ridge leaving a rectangular deficiency of anterior capsule. Medial anchors were then inserted into the acetabulum under fluoroscopy to ensure no intra-articular penetration. Anticipated position of anchors at the trochanteric ridge was identified and marked with a Bovie. Measurements were made between anchors using a measuring device. The arthro flex graph was prepared on the back table using the measurements leaving approximately 5-10 mm at the margins of the graft. Scorpion suture Passer was used to shuttle sutures from the medial row anchors bridging the repair suture between the anchors. The graft was then reduced to the extra-articular acetabular margin. Next the femoral anchors were placed and sutures were retrieved through the cannula and passed through the lateral margin of the graft in a similar configuration using a scorpion suture Passer. Anchor limbs were tensioned to the graft was were reduced. 2. FiberWire suture was then used in simple fashion to repair the graft to the remaining capsular tissue at the superior and inferior margin. This was performed with a scorpion suture Passer for a side-to-side repair. Each stitch was tied with multiple half hitch knots. Three repair stitches were performed at both the superior and inferior margins offering good reduction and good fixation of the graft.
The surgical site was then thoroughly irrigated followed by closure of the skin.
Incisions were closed with 3-0 nylon suture in simple fashion. A sterile dressing was then applied consisting of Xeroform, 4x4, ABD pad. and tape.
Any help is greatly appreciated!!
The hip was then sterilely prepped followed by draping with a barrier drape centered over the anticipated surgical site. Fluoroscopy was then positioned and distraction of the hip joint was achieved with fine traction applied to the Hana table. Time in traction was noted and monitored throughout the case.
The surgical incisions were planned out. An anterior lateral portal was established 1st. A spinal needle was inserted just anterior and proximal to the tip of the greater trochanter and advanced into the hip joint under fluoroscopic guidance. A Nitinol wire was then placed into the joint with removal of the spinal needle a longitudinal incision was made at the wire entry site. Portal was dilated to the hip joint and a 4.5 mm cannula was inserted followed by the arthroscope. A mid anterior portal was then established in a similar fashion with spinal needle localization under direct arthroscopic visualization. A 5.5 mm cannula was then inserted over the Nitinol wire and the arthroscope was moved to the mid anterior portal for evaluation of the placement of anterior lateral portal to ensure no penetration of the labrum. The arthroscope was then moved back to the anterior lateral portal and diagnostic arthroscopy was then performed with the above findings.
Large area capsular deficiency was identified. In addition there was some remaining CAM lesion bone at the femoral head neck junction identified as a possible impinging structure and therefore revision of the femoroplasty was performed to complete the CAM resection, this was performed with a round bur. Decision was made to perform capsule reconstruction. Two additional portals were then established with spinal needle localization both the distal anterior lateral accessory portal and a proximal mid anterior portal. Trim it cannula was then measured and positioned through the anterior lateral portal. Tissue over the acetabular rim was debrided taking care to preserve the previous labral repair which showed no significant abnormalities. A bur was used to decorticate bone at the footprint of where the graft would sit. The medial edge of the capsule showed retained suture from previous attempted repair. The superior and inferior aspects of the capsulectomy were identified in tissue debrided around the margins of the capsule. Each limb of the remaining capsule was attempted to be reapproximated with no ability to approximate the capsular tissue. Debridement was then performed to the trochanteric ridge leaving a rectangular deficiency of anterior capsule. Medial anchors were then inserted into the acetabulum under fluoroscopy to ensure no intra-articular penetration. Anticipated position of anchors at the trochanteric ridge was identified and marked with a Bovie. Measurements were made between anchors using a measuring device. The arthro flex graph was prepared on the back table using the measurements leaving approximately 5-10 mm at the margins of the graft. Scorpion suture Passer was used to shuttle sutures from the medial row anchors bridging the repair suture between the anchors. The graft was then reduced to the extra-articular acetabular margin. Next the femoral anchors were placed and sutures were retrieved through the cannula and passed through the lateral margin of the graft in a similar configuration using a scorpion suture Passer. Anchor limbs were tensioned to the graft was were reduced. 2. FiberWire suture was then used in simple fashion to repair the graft to the remaining capsular tissue at the superior and inferior margin. This was performed with a scorpion suture Passer for a side-to-side repair. Each stitch was tied with multiple half hitch knots. Three repair stitches were performed at both the superior and inferior margins offering good reduction and good fixation of the graft.
The surgical site was then thoroughly irrigated followed by closure of the skin.
Incisions were closed with 3-0 nylon suture in simple fashion. A sterile dressing was then applied consisting of Xeroform, 4x4, ABD pad. and tape.
Any help is greatly appreciated!!