dyoungberg
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Dr performed Arthrotomy, transfer of juvenile cartilage to the retropatellar surface & transfer of cartilage to medial femoral condyle. (op report below)
I have a couple of questions:
1. I believe this is the DeNovo procedure and would be billed using unlisted procedure code 27599.
2. If so, I've seen reference to billing unlisted codes and "comparing" them to another procedure code. Can anyone tell me how we send the "comparing" info to the insurance company? Is it a special form? A written letter? I've never done this and need some guidance.
2. Can I bill separately for the Cartilage transfer to the medial femoral condyle?
Any assistance you can provide to me will be greatly appreciated.
PREOPERATIVE DIAGNOSIS: TRAUMATIC DEFECT, RETROPATELLAR SURFACE
POSTOPERATIVE DIAGNOSIS: 1. TRAUMATIC DEFECT, RETROPATELLAR SURFACE
2. TRAUMATIC DEFECT, MEDIAL FEMORAL CONDYLE
PROCEDURE: 1. ARTHROTOMY
2. TRANSFER OF JUVENILE CARTILAGE TO THE RETROPATELLAR SURFACE
3. TRANSFER OF CARTILAGE TO THE MEDIAL FEMORAL CONDYLE
TECHNIQUE: After obtaining satisfactory level of general anesthesia, the right knee was prepped and draped in a routine fashion. A midline incision was then made, centered above the patella, almost to the tibial tubercle. Using sharp dissection the subcutaneous tissue was dissected. A medial parapatellar arthrotomy was used to enter the joint. The patella was everted. There was severe erosion of the patella. There was also significant and severe erosion of the medial femoral condyle. The defects in the patella and in the condyle were debrided with a curette to give vertical edges and to a depth of the subchondral bone without bleeding. The medial side was treated first. His knee was held in flexion to allow gravity to assist us. Fibrin glue in a very thin layer was placed at the bottom of the defect and allowed to reach a jelly phase. The juvenile cartilage was then placed piecemeal in the defect and covered with fibrin glue. This was allowed to set for about five minutes and filled the defect quite nicely. In a similar fashion fibrin glue was placed about the defect of the patella and after this glue reached a gelatin phase the juvenile cartilage was placed in the defect and covered with more fibrin glue and allowed to set. This period of time was approximately five minutes. This defect was gently palpated and the juvenile cartilage appeared to be intact. The knee was then extended and the medial parapatellar incision closed with absorbable sutures. The skin was closed with staples. A sterile bulky compression dressing was then applied. He was transferred to the cart and sent to the recovery room in satisfactory condition. I spoke to his wife at the termination of the
procedure. Office follow up was recommended next week. Lortab 10 was left for postop pain.
Debbie Youngberg, CPC
NW FL Surgery Center
I have a couple of questions:
1. I believe this is the DeNovo procedure and would be billed using unlisted procedure code 27599.
2. If so, I've seen reference to billing unlisted codes and "comparing" them to another procedure code. Can anyone tell me how we send the "comparing" info to the insurance company? Is it a special form? A written letter? I've never done this and need some guidance.
2. Can I bill separately for the Cartilage transfer to the medial femoral condyle?
Any assistance you can provide to me will be greatly appreciated.
PREOPERATIVE DIAGNOSIS: TRAUMATIC DEFECT, RETROPATELLAR SURFACE
POSTOPERATIVE DIAGNOSIS: 1. TRAUMATIC DEFECT, RETROPATELLAR SURFACE
2. TRAUMATIC DEFECT, MEDIAL FEMORAL CONDYLE
PROCEDURE: 1. ARTHROTOMY
2. TRANSFER OF JUVENILE CARTILAGE TO THE RETROPATELLAR SURFACE
3. TRANSFER OF CARTILAGE TO THE MEDIAL FEMORAL CONDYLE
TECHNIQUE: After obtaining satisfactory level of general anesthesia, the right knee was prepped and draped in a routine fashion. A midline incision was then made, centered above the patella, almost to the tibial tubercle. Using sharp dissection the subcutaneous tissue was dissected. A medial parapatellar arthrotomy was used to enter the joint. The patella was everted. There was severe erosion of the patella. There was also significant and severe erosion of the medial femoral condyle. The defects in the patella and in the condyle were debrided with a curette to give vertical edges and to a depth of the subchondral bone without bleeding. The medial side was treated first. His knee was held in flexion to allow gravity to assist us. Fibrin glue in a very thin layer was placed at the bottom of the defect and allowed to reach a jelly phase. The juvenile cartilage was then placed piecemeal in the defect and covered with fibrin glue. This was allowed to set for about five minutes and filled the defect quite nicely. In a similar fashion fibrin glue was placed about the defect of the patella and after this glue reached a gelatin phase the juvenile cartilage was placed in the defect and covered with more fibrin glue and allowed to set. This period of time was approximately five minutes. This defect was gently palpated and the juvenile cartilage appeared to be intact. The knee was then extended and the medial parapatellar incision closed with absorbable sutures. The skin was closed with staples. A sterile bulky compression dressing was then applied. He was transferred to the cart and sent to the recovery room in satisfactory condition. I spoke to his wife at the termination of the
procedure. Office follow up was recommended next week. Lortab 10 was left for postop pain.
Debbie Youngberg, CPC
NW FL Surgery Center