awest
Networker
Can I bill 29875(6) or would it be included in the chondroplasty and meniscectomies?
Thanks for any input!
Ann West
REOPERATIVE DIAGNOSIS: Rule out right internal knee derangement.
POSTOPERATIVE DIAGNOSES: Rule out right internal knee derangement with medial and lateral meniscal tears, chondromalacia of three compartments, and medial plica.
PROCEDURES
1. Right knee diagnostic arthroscopy.
2. Partial medial and lateral meniscectomies.
3. Chondroplasty, three compartments.
4. Resection of medial plica.
SURGICAL INDICATIONS: The patient is a 76-year-old white male with history of right knee pain and swelling, unresponsive to conservative treatment measures with an MRI evaluation that had shown a medial meniscal tear. He is brought to surgery at this time for diagnostic arthroscopy and debridement. The patient and family understand the possible risks and complications of the surgery to include, but not be limited to neurovascular compromise, infection, pain, stiffness, instability, arthritis, thrombophlebitis, weakness, continued problems, recurrence, death, and sepsis.
PROCEDURE: The patient was brought to the operating room in a premedicated state and placed on the operating room table in a supine position. Following induction of adequate general LMA anesthesia by Dr. Patricia Burns and after being given prophylactic antibiotics, the right knee was then prepped and draped in the usual sterile fashion.
The pneumatic tourniquet was Esmarch inflated to 275 mmHg, following which a standard diagnostic two-portal arthroscopy was carried out with initial findings showing the suprapatellar pouch clear of loose bodies with normal patellofemoral tracking and areas of grade 3 chondromalacia along the femoral sulcus with chondral flaps that were débrided with a motorized shaver in the form of a chondroplasty in the patellofemoral compartment. Both medial and lateral gutters showed to be clear of loose bodies. A view into the medial compartment showed a posterior horn medial meniscal tear horizontal in nature, which was resected with straight and upbiting duckbill scissors and smoothed over with a motorized shaver in the form of a partial medial meniscectomy. There was noted to be some truncation of the medial meniscus in the medial aspect compatible with the prior partial meniscectomy. This was débrided and smoothed over as best as possible with a motorized shaver. The medial femoral condyle showed areas of grade 3 chondromalacia, which was smoothed over with a motorized shaver in the form of a chondroplasty in the medial compartment. The notch view showed the anterior cruciate ligament intact. The lateral compartment showed a small radial tear in the lateral third of the lateral meniscus, which was resected with straight duckbill scissors and smoothed over with a motorized shaver in the form of a partial lateral meniscectomy. There was some grade 2 and 3 chondromalacia along the most medial aspect of the lateral tibial plateau, which was smoothed over with a motorized shaver in the form of a chondroplasty in the lateral compartment. The popliteus hiatus and tendon appeared intact. The posterior aspect of the knee showed to be clear of loose bodies. A final search for loose bodies was performed, none were found. The knee was then irrigated with 2 liters of normal saline, suctioned out, and the portal sites were injected with 0.25% Marcaine with epinephrine, Depo-Medrol, and Duramorph. The knee was taken through a range of motion, following which the portal sites were closed with interrupted everting 4-0 nylon sutures. The wounds were covered with Adaptic, 4 x 4s, sterile cast padding, and an Ace wrap for gentle compression. Tourniquet was released. There was noted to be good capillary refilling and good distal pulses, and the patient was sent to recovery room in a stable condition. He will be maintained on Percocet and Phenergan postoperatively, will have follow-up with Dr. Lancaster in one week's time, and will contact Dr. Lancaster for problems with increased pain, swelling, cyanosis, edema, numbness, paresthesias, or bleeding. Sponge and instrument counts were reported correct to the surgeon by the nursing staff.
SUMMARY: The patient underwent a right knee arthroscopy with partial medial and lateral meniscectomies for medial and lateral meniscal tears, and a chondroplasty in three compartments, namely the patellofemoral compartment, medial compartment, and lateral compartment, and as such will qualify as a full chondroplasty since this occurred in compartments other than the meniscectomy sites. A partial synovectomy and resection of the medial plica was similarly performed across the impinging area along the medial aspect of the patellofemoral joint to prevent further impingement.
Thanks for any input!
Ann West
REOPERATIVE DIAGNOSIS: Rule out right internal knee derangement.
POSTOPERATIVE DIAGNOSES: Rule out right internal knee derangement with medial and lateral meniscal tears, chondromalacia of three compartments, and medial plica.
PROCEDURES
1. Right knee diagnostic arthroscopy.
2. Partial medial and lateral meniscectomies.
3. Chondroplasty, three compartments.
4. Resection of medial plica.
SURGICAL INDICATIONS: The patient is a 76-year-old white male with history of right knee pain and swelling, unresponsive to conservative treatment measures with an MRI evaluation that had shown a medial meniscal tear. He is brought to surgery at this time for diagnostic arthroscopy and debridement. The patient and family understand the possible risks and complications of the surgery to include, but not be limited to neurovascular compromise, infection, pain, stiffness, instability, arthritis, thrombophlebitis, weakness, continued problems, recurrence, death, and sepsis.
PROCEDURE: The patient was brought to the operating room in a premedicated state and placed on the operating room table in a supine position. Following induction of adequate general LMA anesthesia by Dr. Patricia Burns and after being given prophylactic antibiotics, the right knee was then prepped and draped in the usual sterile fashion.
The pneumatic tourniquet was Esmarch inflated to 275 mmHg, following which a standard diagnostic two-portal arthroscopy was carried out with initial findings showing the suprapatellar pouch clear of loose bodies with normal patellofemoral tracking and areas of grade 3 chondromalacia along the femoral sulcus with chondral flaps that were débrided with a motorized shaver in the form of a chondroplasty in the patellofemoral compartment. Both medial and lateral gutters showed to be clear of loose bodies. A view into the medial compartment showed a posterior horn medial meniscal tear horizontal in nature, which was resected with straight and upbiting duckbill scissors and smoothed over with a motorized shaver in the form of a partial medial meniscectomy. There was noted to be some truncation of the medial meniscus in the medial aspect compatible with the prior partial meniscectomy. This was débrided and smoothed over as best as possible with a motorized shaver. The medial femoral condyle showed areas of grade 3 chondromalacia, which was smoothed over with a motorized shaver in the form of a chondroplasty in the medial compartment. The notch view showed the anterior cruciate ligament intact. The lateral compartment showed a small radial tear in the lateral third of the lateral meniscus, which was resected with straight duckbill scissors and smoothed over with a motorized shaver in the form of a partial lateral meniscectomy. There was some grade 2 and 3 chondromalacia along the most medial aspect of the lateral tibial plateau, which was smoothed over with a motorized shaver in the form of a chondroplasty in the lateral compartment. The popliteus hiatus and tendon appeared intact. The posterior aspect of the knee showed to be clear of loose bodies. A final search for loose bodies was performed, none were found. The knee was then irrigated with 2 liters of normal saline, suctioned out, and the portal sites were injected with 0.25% Marcaine with epinephrine, Depo-Medrol, and Duramorph. The knee was taken through a range of motion, following which the portal sites were closed with interrupted everting 4-0 nylon sutures. The wounds were covered with Adaptic, 4 x 4s, sterile cast padding, and an Ace wrap for gentle compression. Tourniquet was released. There was noted to be good capillary refilling and good distal pulses, and the patient was sent to recovery room in a stable condition. He will be maintained on Percocet and Phenergan postoperatively, will have follow-up with Dr. Lancaster in one week's time, and will contact Dr. Lancaster for problems with increased pain, swelling, cyanosis, edema, numbness, paresthesias, or bleeding. Sponge and instrument counts were reported correct to the surgeon by the nursing staff.
SUMMARY: The patient underwent a right knee arthroscopy with partial medial and lateral meniscectomies for medial and lateral meniscal tears, and a chondroplasty in three compartments, namely the patellofemoral compartment, medial compartment, and lateral compartment, and as such will qualify as a full chondroplasty since this occurred in compartments other than the meniscectomy sites. A partial synovectomy and resection of the medial plica was similarly performed across the impinging area along the medial aspect of the patellofemoral joint to prevent further impingement.