orthopaedic01
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DX: Anserine bursitis left knee and scarred fat left knee
PROCEDURE: Excision of subcut. fat and decompression of anserine bursa with lysis of adhesions from the semitendinosus tendon.
DETAILS: Long. incision was made over the anteromedial aspect of the distal knee overlying the pes anserinus. Dissection was carried through subcut. tissue and there was seen to be a thickened scarred collection of subcut. fat in the region and this was what was responsible for the palpable mass. This fat was excised and sent to pathology. The tissue overlying the anserine bursa was divided and the superior edge of the gracilis was retracted thereby identifying the semintendinosus tendon. This was found to be scarred and adhered with a slight amount of inflammatory tissue present on its inferior surface. The scarring and inflammatory tissue was debrided. Wound was irrigated thoroughly and closed in layers.
I was thinking 27323 for the excision of the subcut. fat mass. Even though this is a biopsy code the lay terms state "incision is made over the biopsy area. Dissection is carried down within the superficial soft tissue layers in 27323, usually the subcutaneous fat to the uppermost fascial layer. A portion of the tissue is excised and submitted for pathology"
I was thinking of 27496 for the decompression of the anserine bursa...but just not sure.
As far as the debridement of the tendon, I don't have a clue. You can't use 29877 because that's debriding cartilage, not a tendon.
Any help/ideas would be most appreciated!