anwalden
Guest
I'm trying to code the 2nd ICD-9 for this procedure, and can't find a code that fits Medial Femoral Condyle Injury, or Chondral Flap Tears. Any ideas? Thanks!! 
Operative Report
PREOPERATIVE DIAGNOSIS: Medial meniscus tear.
POSTOPERATIVE DIAGNOSIS: Medical meniscus and medial femoral condyle injury.
PROCEDURE: Arthroscopic knee surgery with partial anterior medial meniscectomy and debridement of chondral flap tears of the medial femoral condyle.
ANESTHESIA: Local MAC.
INDICATIONS AND CONSENT: The patient is a man who injured his knee climbing down off a ladder at work. With that, he had immediate pain. His pain has not resolved. He continues to have catching, popping, and giving away sensations. After our thorough discussion of risks, complications, and alternatives, what we elected to do is proceed with an arthroscopy.
PROCEDURE: The patient was brought to the operating room where a timeout was done. Person, place, allergies, and antibiotics were all confirmed. He was placed on the operating room table where general anesthesia was initiated. We injected his knee with a Xylocaine and Marcaine solution over the arthroscopy portals for anticipated arthroscopy. Standard prepping and draping was done followed by a three-portal arthroscopy.
Evaluation was done first of the patellofemoral articulation. The midpoint of the distal pole of the patella had a small area of chondral injury with a chondral flap tear. That was thoroughly seen, probed, and then shaved down. There were no further unstable fragments. It was, perhaps, a 20%% thickness of the articular cartilage depth. The lateral joint line was seen. The lateral meniscus was intact throughout. There were a couple of small chondral pieces floating around that were removed with a shaver. However, when I got done, there was really no significant injury to the lateral meniscus. There was just a very slight abrasion where it appears a loose body must have jammed into the lateral side, and that was shaved down. When I was done, I turned my attention to the ACL.
The ACL was seen, probed, and found to be intact. The PCL could not be seen, but the knee was stable. On the medial side where I thought the problem was, indeed on entering, there was a very large 1 x 1 cm by, perhaps, a 40%% thickness of the cartilage depth flaps of articular cartilage. I probed those, documented those, and shaved those with a shaver. With that smoothed out, I looked at the rest of the knee. The posterior meniscus was intact as was the mid-medial aspect. Then going anterior, there was a fairly significant bucket handle-type tear of the anterior horn. It had quite a bit of hypertrophy of the synovium around it. I went ahead and bit that out, and with that removed, I felt the cause of the articular damage on the femur was resolved. The tibial side was in excellent shape.
After copious irrigation, the wound was closed. Closure consisted of 5-0 nylon on the skin followed by placement of a Tega-Steri. The patient had a sterile dressing applied and was brought to the recovery room in good condition. No complications.
Operative Report
PREOPERATIVE DIAGNOSIS: Medial meniscus tear.
POSTOPERATIVE DIAGNOSIS: Medical meniscus and medial femoral condyle injury.
PROCEDURE: Arthroscopic knee surgery with partial anterior medial meniscectomy and debridement of chondral flap tears of the medial femoral condyle.
ANESTHESIA: Local MAC.
INDICATIONS AND CONSENT: The patient is a man who injured his knee climbing down off a ladder at work. With that, he had immediate pain. His pain has not resolved. He continues to have catching, popping, and giving away sensations. After our thorough discussion of risks, complications, and alternatives, what we elected to do is proceed with an arthroscopy.
PROCEDURE: The patient was brought to the operating room where a timeout was done. Person, place, allergies, and antibiotics were all confirmed. He was placed on the operating room table where general anesthesia was initiated. We injected his knee with a Xylocaine and Marcaine solution over the arthroscopy portals for anticipated arthroscopy. Standard prepping and draping was done followed by a three-portal arthroscopy.
Evaluation was done first of the patellofemoral articulation. The midpoint of the distal pole of the patella had a small area of chondral injury with a chondral flap tear. That was thoroughly seen, probed, and then shaved down. There were no further unstable fragments. It was, perhaps, a 20%% thickness of the articular cartilage depth. The lateral joint line was seen. The lateral meniscus was intact throughout. There were a couple of small chondral pieces floating around that were removed with a shaver. However, when I got done, there was really no significant injury to the lateral meniscus. There was just a very slight abrasion where it appears a loose body must have jammed into the lateral side, and that was shaved down. When I was done, I turned my attention to the ACL.
The ACL was seen, probed, and found to be intact. The PCL could not be seen, but the knee was stable. On the medial side where I thought the problem was, indeed on entering, there was a very large 1 x 1 cm by, perhaps, a 40%% thickness of the cartilage depth flaps of articular cartilage. I probed those, documented those, and shaved those with a shaver. With that smoothed out, I looked at the rest of the knee. The posterior meniscus was intact as was the mid-medial aspect. Then going anterior, there was a fairly significant bucket handle-type tear of the anterior horn. It had quite a bit of hypertrophy of the synovium around it. I went ahead and bit that out, and with that removed, I felt the cause of the articular damage on the femur was resolved. The tibial side was in excellent shape.
After copious irrigation, the wound was closed. Closure consisted of 5-0 nylon on the skin followed by placement of a Tega-Steri. The patient had a sterile dressing applied and was brought to the recovery room in good condition. No complications.
