cclarson
Guru
Hello Everyone,
After doing some research, I've learned that the biopsy of cartilage for a future MACI procedure is 29870. However, a loose body was also removed which is 29874, and I know that normally you can no longer code a diagnostic arthroscopic code once an actual arthroscopic procedure has been performed. However, again, loose body removal is usually bundled with any other procedure performed. Sigh, haha. So should I code both, or only one of them? Let me know what you think!
POSTOPERATIVE DIAGNOSES:
1. Right knee osteochondral fracture of the lateral femoral condyle and patella.
2. Right knee patella traumatic lateral dislocation.
3. Right knee loose body.
PROCEDURES PERFORMED:
1. Right knee arthroscopy with loose body removal measuring 1.5 x 2 cm.
2. Right knee biopsy of cartilage for planned return with MACI procedure.
INDICATIONS:
This is 35-year-old gentleman who suffered work related injury where he sustained a patellar dislocation with MRI findings consistent with lateral patella dislocation with osteochondral fractures of the medial facet of the patella as well as lateral femoral condyle, questionable loose body. He failed a long course conservative measures, continued to have pain ultimately recommended return for repair of the medial patellofemoral ligament with possibility of cartilage biopsy. The risks, benefits, and alternatives were discussed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative holding area. The left knee was marked as the operative site. He received standard preoperative antibiotics. He was taken back to the operating suite and placed in supine position. General anesthesia was given. Exam revealed no effusion, full motion, stable Lachman, no instability to varus or valgus stress and a 1 to 2 plus lateral glide of the patella. The right knee was then prepped and draped in the usual sterile fashion. Timeout was performed prior to incision. Once all had agreed we proceeded. An anterolateral portal was created. The scope was placed into the patellofemoral joint.
On viewing of the patella there appeared to be significant lateralization of the patella with grade 2 and 3 chondral derangement at the apex of the lateral facet. The trochlear groove was normal, but somewhat dysplastic. The lateral gutter appeared to have a large loose fragment. Due to this a medial portal was then established. The scope was switched into the medial portal. The lateral portal was enlarged, and a hemostat was then inserted and the loose body was then removed. This measured approximately 1.5 x 2 cm. At that point where we finished our diagnostic arthroscopy. The medial compartment, ACL, PCL, and lateral compartment were inspected. The medial compartment, normal. The ACL and PCL intact. The lateral compartment demonstrated an area on the lateral femoral condyle which appeared to be the donor site of the loose body. This was very lateral in the area that was impacted during the dislocation. This appeared to be scarred over fairly nicely with good scar cartilage. The lateral compartment was otherwise normal. At that point given the findings at the apex of the patella we inspected it from the medial portal. There was significant grade 2 and 3 chondral derangement measuring approximately 2 by 1.5 to 2 cm. Given these findings my recommendation at that point was to perform a cartilage biopsy in plans for coming back for a staged procedure to perform a MACI procedure with MPFL reconstruction and tibial tubercle osteotomy.
At that point the scope was removed. The joint suction free of fluid. The portals were closed with 3-0 nylon. Then 30 mL 0.5% Marcaine were injected in the knee and sterile dressings were placed. The patient was awoken from anesthesia and taken to the recovery room in stable condition.
After doing some research, I've learned that the biopsy of cartilage for a future MACI procedure is 29870. However, a loose body was also removed which is 29874, and I know that normally you can no longer code a diagnostic arthroscopic code once an actual arthroscopic procedure has been performed. However, again, loose body removal is usually bundled with any other procedure performed. Sigh, haha. So should I code both, or only one of them? Let me know what you think!
POSTOPERATIVE DIAGNOSES:
1. Right knee osteochondral fracture of the lateral femoral condyle and patella.
2. Right knee patella traumatic lateral dislocation.
3. Right knee loose body.
PROCEDURES PERFORMED:
1. Right knee arthroscopy with loose body removal measuring 1.5 x 2 cm.
2. Right knee biopsy of cartilage for planned return with MACI procedure.
INDICATIONS:
This is 35-year-old gentleman who suffered work related injury where he sustained a patellar dislocation with MRI findings consistent with lateral patella dislocation with osteochondral fractures of the medial facet of the patella as well as lateral femoral condyle, questionable loose body. He failed a long course conservative measures, continued to have pain ultimately recommended return for repair of the medial patellofemoral ligament with possibility of cartilage biopsy. The risks, benefits, and alternatives were discussed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified in the preoperative holding area. The left knee was marked as the operative site. He received standard preoperative antibiotics. He was taken back to the operating suite and placed in supine position. General anesthesia was given. Exam revealed no effusion, full motion, stable Lachman, no instability to varus or valgus stress and a 1 to 2 plus lateral glide of the patella. The right knee was then prepped and draped in the usual sterile fashion. Timeout was performed prior to incision. Once all had agreed we proceeded. An anterolateral portal was created. The scope was placed into the patellofemoral joint.
On viewing of the patella there appeared to be significant lateralization of the patella with grade 2 and 3 chondral derangement at the apex of the lateral facet. The trochlear groove was normal, but somewhat dysplastic. The lateral gutter appeared to have a large loose fragment. Due to this a medial portal was then established. The scope was switched into the medial portal. The lateral portal was enlarged, and a hemostat was then inserted and the loose body was then removed. This measured approximately 1.5 x 2 cm. At that point where we finished our diagnostic arthroscopy. The medial compartment, ACL, PCL, and lateral compartment were inspected. The medial compartment, normal. The ACL and PCL intact. The lateral compartment demonstrated an area on the lateral femoral condyle which appeared to be the donor site of the loose body. This was very lateral in the area that was impacted during the dislocation. This appeared to be scarred over fairly nicely with good scar cartilage. The lateral compartment was otherwise normal. At that point given the findings at the apex of the patella we inspected it from the medial portal. There was significant grade 2 and 3 chondral derangement measuring approximately 2 by 1.5 to 2 cm. Given these findings my recommendation at that point was to perform a cartilage biopsy in plans for coming back for a staged procedure to perform a MACI procedure with MPFL reconstruction and tibial tubercle osteotomy.
At that point the scope was removed. The joint suction free of fluid. The portals were closed with 3-0 nylon. Then 30 mL 0.5% Marcaine were injected in the knee and sterile dressings were placed. The patient was awoken from anesthesia and taken to the recovery room in stable condition.
