ahalle
Contributor
Has anyone ever coded a balloon tibioplasty? One of my doctors just did this procedure and I'm at a loss for coding. I imagine 27599 unlisted procedure is correct but what on earth do I compare it to? I've never heard of anything similar other than kyphoplasty(22513) and the site manager just shot that down as a comparison. So if anyone has any thoughts on the coding, I would be glad to hear them.
Procedure note:
A lateral tibial plateau plate is in good position and alignment, seated to the lateral tibia plateau. A poke hole incision is made over one of the proximal locking screws, as it is in the area where the tibioplasty is to be accomplished. The appropriate sized screwdriver is chosen, and now, this proximal locking screw is removed from the patient’s right knee. Now having done this, the balloon plasty device is placed through this wound and into the tibia plateau. This is done using C-arm visualization to ensure proper placement of this tool. Now that the trocar is in the appropriate position in the anteroposterior and lateral planes, the balloon is inflated. Due to the other proximal locking screws, the balloon after inflation to approximately 50-percent actually ruptured. Dye placement into the tibia plateau showed proper placement of the balloon, but because of the rupture, this was removed. Partial tibioplasty was accomplished using the balloon in this area.
Then, a second balloon was introduced. The position was slightly moved in hopes of getting a better tibioplasty and opening of this area. With the second balloon, it was inflated to roughly 50-percent. Dye showed it to be in the proper position, but the second balloon also ruptured. Having dilated the lateral tibial plateau to some extent, the calcium phosphate bone substitute is now injected into the lateral tibial plateau. The injection device is placed into the lateral tibial plateau and proper placement of this is confirmed on anteroposterior and lateral planes using fluoroscopy. With the injection needle in the appropriate position, the calcium phosphate bone substitute is injected into the lateral tibial plateau. Then, the injection device is removed. After this, the wounds of the lateral aspect of the right knee are irrigated with sterile saline. The wounds are then closed with #2-0 nylon in a simple type fashion. At this time, the knee joint itself is injected with bone marrow aspirate concentrate and Cellgenuity amniotic fluid.
Procedure note:
A lateral tibial plateau plate is in good position and alignment, seated to the lateral tibia plateau. A poke hole incision is made over one of the proximal locking screws, as it is in the area where the tibioplasty is to be accomplished. The appropriate sized screwdriver is chosen, and now, this proximal locking screw is removed from the patient’s right knee. Now having done this, the balloon plasty device is placed through this wound and into the tibia plateau. This is done using C-arm visualization to ensure proper placement of this tool. Now that the trocar is in the appropriate position in the anteroposterior and lateral planes, the balloon is inflated. Due to the other proximal locking screws, the balloon after inflation to approximately 50-percent actually ruptured. Dye placement into the tibia plateau showed proper placement of the balloon, but because of the rupture, this was removed. Partial tibioplasty was accomplished using the balloon in this area.
Then, a second balloon was introduced. The position was slightly moved in hopes of getting a better tibioplasty and opening of this area. With the second balloon, it was inflated to roughly 50-percent. Dye showed it to be in the proper position, but the second balloon also ruptured. Having dilated the lateral tibial plateau to some extent, the calcium phosphate bone substitute is now injected into the lateral tibial plateau. The injection device is placed into the lateral tibial plateau and proper placement of this is confirmed on anteroposterior and lateral planes using fluoroscopy. With the injection needle in the appropriate position, the calcium phosphate bone substitute is injected into the lateral tibial plateau. Then, the injection device is removed. After this, the wounds of the lateral aspect of the right knee are irrigated with sterile saline. The wounds are then closed with #2-0 nylon in a simple type fashion. At this time, the knee joint itself is injected with bone marrow aspirate concentrate and Cellgenuity amniotic fluid.