vmounce
Guru
I am confused on this one. Since the MPFL is extra-articular I think CPT wound be 27427. Can someone look at the note below and tell me if the codes below are correct that the surgeon wants to use. I appreciate the information. Please see below.
Vickie
Rt knee MPFL reconstruction with semi-T allograft cpt 27428
Rt knee tibial tubercle osteotomy cpt 27418
Rt knee VMO advancement for patella instability cpt 27422
Rt knee diagnostic arthroscopy cpt 29870
The patient was met in the preoperative suite where the correct operative site was marked. The patient was brought to the operating room where anesthesia was initiated. The patient was positioned appropriately with all bony prominences well padded. The patient was prepped and draped in the usual sterile fashion and prior to incision a timeout was observed to verify the correct operative site, procedure and antibiotics.
Anterior lateral portal was created and a scope was introduced into the supra parapatellar pouch. A thorough diagnostic arthroscopy was performed to determine any containment pathology that need to be addressed arthroscopically which there was no chondral damage or other injury noted within the knee that need to be addressed. The findings are noted above.
Attention was then brought to the anterior aspect the tibial tubercle with a midline incision was taken down to the extensor mechanism. Medial and lateral flaps were created. The anterior musculature on the lateral aspect was elevated with electrocautery and an elevator. The Arthrex AMZ guide was utilized to make a 45 degree osteotomy. This was performed with a combination of oscillating saws and osteotomes. The osteotomy was moved medially 1 cm and held into position with 3 K wires with one K wire out of plane. 4.5 mm cannulated fully threaded screws were placed under lag technique. This was done with intraoperative fluoroscopy.
Attention was then brought to the medial aspect of the patella and distal thigh with a longitudinal incision just medial to the patella. The medial aspect of the patella was exposed and a rongeur was utilized to create a trough. This was down to bleeding bone. Just deep to the VMO muscle dissection to the distal medial aspect of the thigh was taken down. A graft was prepped once thawed on the back table and attached to 2 swivel lock anchors were which were then placed into the patella. This was done with the aid of intraoperative fluoroscopy. The graft was passed to a small posterior incision. A guide pin was utilized with a perfect lateral intraoperative x-ray at Schottle's point. A reamer was utilized to create a femoral socket and the graft was passed within the socket and tightened with a graft link as well as a soft tissue BioScrew. This was done with 50% of the patella in the trochlear groove in roughly 30 degrees flexion.
All wounds were thoroughly irrigated with sterile saline. Safety sutures from the patella was then used to advance the VMO distally for further stabilization of the patella. The remainder of the wounds were closed in standard layered fashion. A soft dressing was applied. The patient was placed in a knee immobilizer in extension. The patient was extubated, transferred to hospital bed in the PACU in stable condition.. The patient tolerated procedure well without any complications.
Vickie
Rt knee MPFL reconstruction with semi-T allograft cpt 27428
Rt knee tibial tubercle osteotomy cpt 27418
Rt knee VMO advancement for patella instability cpt 27422
Rt knee diagnostic arthroscopy cpt 29870
The patient was met in the preoperative suite where the correct operative site was marked. The patient was brought to the operating room where anesthesia was initiated. The patient was positioned appropriately with all bony prominences well padded. The patient was prepped and draped in the usual sterile fashion and prior to incision a timeout was observed to verify the correct operative site, procedure and antibiotics.
Anterior lateral portal was created and a scope was introduced into the supra parapatellar pouch. A thorough diagnostic arthroscopy was performed to determine any containment pathology that need to be addressed arthroscopically which there was no chondral damage or other injury noted within the knee that need to be addressed. The findings are noted above.
Attention was then brought to the anterior aspect the tibial tubercle with a midline incision was taken down to the extensor mechanism. Medial and lateral flaps were created. The anterior musculature on the lateral aspect was elevated with electrocautery and an elevator. The Arthrex AMZ guide was utilized to make a 45 degree osteotomy. This was performed with a combination of oscillating saws and osteotomes. The osteotomy was moved medially 1 cm and held into position with 3 K wires with one K wire out of plane. 4.5 mm cannulated fully threaded screws were placed under lag technique. This was done with intraoperative fluoroscopy.
Attention was then brought to the medial aspect of the patella and distal thigh with a longitudinal incision just medial to the patella. The medial aspect of the patella was exposed and a rongeur was utilized to create a trough. This was down to bleeding bone. Just deep to the VMO muscle dissection to the distal medial aspect of the thigh was taken down. A graft was prepped once thawed on the back table and attached to 2 swivel lock anchors were which were then placed into the patella. This was done with the aid of intraoperative fluoroscopy. The graft was passed to a small posterior incision. A guide pin was utilized with a perfect lateral intraoperative x-ray at Schottle's point. A reamer was utilized to create a femoral socket and the graft was passed within the socket and tightened with a graft link as well as a soft tissue BioScrew. This was done with 50% of the patella in the trochlear groove in roughly 30 degrees flexion.
All wounds were thoroughly irrigated with sterile saline. Safety sutures from the patella was then used to advance the VMO distally for further stabilization of the patella. The remainder of the wounds were closed in standard layered fashion. A soft dressing was applied. The patient was placed in a knee immobilizer in extension. The patient was extubated, transferred to hospital bed in the PACU in stable condition.. The patient tolerated procedure well without any complications.