cclarson
Guru
Hello Everyone,
Doctor performed a loose body removal (29874) and decided to debride some of a cartilage flap while he was in there. Would the cartilage flap debridement qualify for 29877? If so, can these be charged separately? or would 29874 bundle into 29877? Let me know what you think! Thank you!
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Moderate right knee osteoarthritis with large loose body.
PROCEDURES PERFORMED:
Right knee arthroscopic loose body removal.
INDICATIONS FOR PROCEDURE:
The patient is a 59-year-old female who is very active and runs competitive marathons and iron man triathlons. She has been experiencing increasing pain in her right knee over the last several months. She has also had a catching sensation and an inability to straighten her leg at times. She has been treated by Dr. Feathers in our office, who referred her to me after conservative treatments failed to relieve her symptoms. She had a MRI which showed a large 9 mm loose body in her intercondylar notch that we thought was contributing to her symptoms. I discussed risks, benefits, and alternatives to surgical treatment with the patient including risks of bleeding, infection, continued knee pain and dysfunction and possible need for more surgery. The patient understood these risks and agreed to proceed with suture. We also had a discussion that she had some preexisting arthritic changes in her knee that would not improve after the surgery. However, her main concern was the catching sensation, inability to straighten her leg at times that we thought was resulting from her loose body. Our hopes were that removal of this would resolve those issues and allow her to continue competitive running.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative area. Her H&P and consent form were signed and updated. She was taken to the operating room and intubated without complication. She was placed supine on the operating table. Her right lower extremity was prepped and draped in normal sterile fashion. Preoperative antibiotics were given.
After a surgical timeout was performed, we started by exsanguinating the limb and inflating the tourniquet to 300 mmHg. We made a lateral portal and entered the knee joint. We made a medial portal under direct visualization. We introduced a shaver to debride some of the synovium overlying the anterior cruciate ligament. We looked first in the medial and lateral compartments. She had grade 3 chondromalacia in each of these compartments. She had some degenerative tearing of the posterior horn of the medial meniscus. I did not see any large horizontal or radial tears that needed any sort of debridement. I left her posterior horn of the meniscus alone as we did not think that was necessarily contributing to any of her symptoms. We then looked in the notch. She had a smaller loose body measuring about 3 or 4 mm across that we removed with an arthroscopic grasper. I then identified her larger 9 to 10 mm loose body. This was located just lateral to the insertion of the anterior cruciate ligament and anterior to her lateral meniscus. We debrided some of the overlying synovium over this and exposed the loose body. We made a 1 cm wide portal medially to introduce our grasper through and then retrieve the loose body in its entirety. We then introduced our shaver to make sure there were no remaining remnants in the area or anywhere else in the intercondylar notch. I looked up in the suprapatellar recess and then the medial and lateral gutters and found no loose bodies in either of those areas. So, I felt confident we had removed as many of those as possible. I did use the shaver to debride a little bit of a chondral flap on the underside of the patella where she had some grade 3 to 4 chondromalacia there as well.
Doctor performed a loose body removal (29874) and decided to debride some of a cartilage flap while he was in there. Would the cartilage flap debridement qualify for 29877? If so, can these be charged separately? or would 29874 bundle into 29877? Let me know what you think! Thank you!
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Moderate right knee osteoarthritis with large loose body.
PROCEDURES PERFORMED:
Right knee arthroscopic loose body removal.
INDICATIONS FOR PROCEDURE:
The patient is a 59-year-old female who is very active and runs competitive marathons and iron man triathlons. She has been experiencing increasing pain in her right knee over the last several months. She has also had a catching sensation and an inability to straighten her leg at times. She has been treated by Dr. Feathers in our office, who referred her to me after conservative treatments failed to relieve her symptoms. She had a MRI which showed a large 9 mm loose body in her intercondylar notch that we thought was contributing to her symptoms. I discussed risks, benefits, and alternatives to surgical treatment with the patient including risks of bleeding, infection, continued knee pain and dysfunction and possible need for more surgery. The patient understood these risks and agreed to proceed with suture. We also had a discussion that she had some preexisting arthritic changes in her knee that would not improve after the surgery. However, her main concern was the catching sensation, inability to straighten her leg at times that we thought was resulting from her loose body. Our hopes were that removal of this would resolve those issues and allow her to continue competitive running.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative area. Her H&P and consent form were signed and updated. She was taken to the operating room and intubated without complication. She was placed supine on the operating table. Her right lower extremity was prepped and draped in normal sterile fashion. Preoperative antibiotics were given.
After a surgical timeout was performed, we started by exsanguinating the limb and inflating the tourniquet to 300 mmHg. We made a lateral portal and entered the knee joint. We made a medial portal under direct visualization. We introduced a shaver to debride some of the synovium overlying the anterior cruciate ligament. We looked first in the medial and lateral compartments. She had grade 3 chondromalacia in each of these compartments. She had some degenerative tearing of the posterior horn of the medial meniscus. I did not see any large horizontal or radial tears that needed any sort of debridement. I left her posterior horn of the meniscus alone as we did not think that was necessarily contributing to any of her symptoms. We then looked in the notch. She had a smaller loose body measuring about 3 or 4 mm across that we removed with an arthroscopic grasper. I then identified her larger 9 to 10 mm loose body. This was located just lateral to the insertion of the anterior cruciate ligament and anterior to her lateral meniscus. We debrided some of the overlying synovium over this and exposed the loose body. We made a 1 cm wide portal medially to introduce our grasper through and then retrieve the loose body in its entirety. We then introduced our shaver to make sure there were no remaining remnants in the area or anywhere else in the intercondylar notch. I looked up in the suprapatellar recess and then the medial and lateral gutters and found no loose bodies in either of those areas. So, I felt confident we had removed as many of those as possible. I did use the shaver to debride a little bit of a chondral flap on the underside of the patella where she had some grade 3 to 4 chondromalacia there as well.
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