I have been having major issues with Aetna and meniscectomies. Would you please review the info below and tell me what you would use as the DX? I would greatly appreciate it!!!
INDICATIONS: This is a 48-year-old gentleman who has had pain over the medial aspect of the knee which has failed the conservative treatment program, who presents. He understands the risks of infection, neurovascular injury, and anesthetic complications associated with surgical intervention.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room, and general endotracheal anesthesia was induced. The patient was then prepped and draped in the supine position with tourniquet around the left thigh and left leg in the leg holder. After exsanguinating the limb, tourniquet was inflated to 300 mmHg. Initially, anterolateral portal was established using first spinal needle and then a vertical stab incision after injecting 30 cc of normal saline. Then 1 cm incision was made inferolateral to the inferior pole of patella and scope was introduced in the suprapatellar pouch. Diagnostic arthroscopy revealed that there were no loose bodies within the suprapatellar pouch, medial, or lateral gutter. Under direct vision, an anteromedial portal was established using the first spinal needle and then a vertical stab incision with a scalpel. Shaver was introduced and a limited synovectomy was performed to allow for visualization of the medial joint space. With the leg in valgus stress and full extension, there was evidence of undersurface tear of the medial meniscus of the posterior horn. Using a combination of shavers and baskets, a partial meniscectomy was performed down to a stable rim. There was no significant osteochondral wear of the medial femoral condyle. Lateral joint line showed no evidence of lateral meniscus tear or chondral injury and the ACL ligament appeared to be intact. There was no significant osteochondral wear of the patellofemoral joint and minimal medial plica. The wounds were irrigated at this time and closed with 3-0 nylon in simple interrupted fashion. A 15 cc bolus of 0.5% ropivacaine injected in the knee and Xeroform, 4 x 4, ABD, Kerlix, and Ace wrap were used to dress the leg. The patient tolerated the procedure well, was extubated, and brought to the Recovery room in a stable condition. All counts, sharps as well as sponges were correct. There were no intraoperative complications.
INDICATIONS: This is a 48-year-old gentleman who has had pain over the medial aspect of the knee which has failed the conservative treatment program, who presents. He understands the risks of infection, neurovascular injury, and anesthetic complications associated with surgical intervention.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room, and general endotracheal anesthesia was induced. The patient was then prepped and draped in the supine position with tourniquet around the left thigh and left leg in the leg holder. After exsanguinating the limb, tourniquet was inflated to 300 mmHg. Initially, anterolateral portal was established using first spinal needle and then a vertical stab incision after injecting 30 cc of normal saline. Then 1 cm incision was made inferolateral to the inferior pole of patella and scope was introduced in the suprapatellar pouch. Diagnostic arthroscopy revealed that there were no loose bodies within the suprapatellar pouch, medial, or lateral gutter. Under direct vision, an anteromedial portal was established using the first spinal needle and then a vertical stab incision with a scalpel. Shaver was introduced and a limited synovectomy was performed to allow for visualization of the medial joint space. With the leg in valgus stress and full extension, there was evidence of undersurface tear of the medial meniscus of the posterior horn. Using a combination of shavers and baskets, a partial meniscectomy was performed down to a stable rim. There was no significant osteochondral wear of the medial femoral condyle. Lateral joint line showed no evidence of lateral meniscus tear or chondral injury and the ACL ligament appeared to be intact. There was no significant osteochondral wear of the patellofemoral joint and minimal medial plica. The wounds were irrigated at this time and closed with 3-0 nylon in simple interrupted fashion. A 15 cc bolus of 0.5% ropivacaine injected in the knee and Xeroform, 4 x 4, ABD, Kerlix, and Ace wrap were used to dress the leg. The patient tolerated the procedure well, was extubated, and brought to the Recovery room in a stable condition. All counts, sharps as well as sponges were correct. There were no intraoperative complications.
