kevans0409
New
I have a physician who performed the following:
1. Rt patellofemoral medial compartmental arthroplasty with MAKO components.
2. Removal of cartilaginous loose body.
3. Microfracture, medial femoral condyle x2.
DX:
1. Patellofemoral arthritis, particularly patella more than trochlear groove with 1 x 2-cm carilage loose body and a 1.5mm x 3-mm grade IV lesion, medial femoral condyle.
Procedure:
... Anterior skin incision was made along just medial to the tibial tubercle to the suprapatellar pouch area about 14cm. Dissection continued .... over the quadriceps. Medial arthrotomy was performed revealing a significant effusion and some synovitis. Synovectomy was accomplished around the patella. Care was taken to protect the anterior horn of the medial meniscus. ACL was intact. Grade III and IV lesions of the patella were noted. The trochlear groove was less involved, however. There was a small 1.5 x 3-mm grade IV lesion in the medial femoral condyle, but there were a much larger cartilaginous loose body in the notch than could be seen from the donor area, more likely the patella. This was a 1 x 2cm cartilaginous loose body, and this was removed. Using an Army-Navy, the remaining part of the joint was inspected, and the lateral compartment was normal.
Attention was now turned to the patella. It was templated to be a 32 and measure about 20mm or so in thickness. The saw guide was a little bulky and therefore free hand with Lahey clamps was accomplished, maintaining 12-13 mm thickness. Three holes were drilled for a 32 and then the 32 trial was placed, still measuring about a 21-mm patellar thickness with excellent patellar tracking. Trial component was removed, and the bone surfaces were prepared for cement fixation. After adequate suction and drying, the Palacos cement was mixed, appropriate consistency was reached. The cement was placed first in the trochlear groove and the femoral component was impacted. Excess cement was removed. In like fashion, the bone surface of the patella was prepared. Cement was placed and the patella button was placed, clamped into place and warm saline was used to accelerate cement hardening. After adequate hardening of the cement, the tourniquet was deflated at 34 minutes. No significant bleeders, except around the fat pad were encountered and were easily controlled with electrocautery. Further irrigation was used and then the medial arthrotomy was closed with a 0 PDS in interrupted figure-of-eight fashion and then a #1 Vicryl in running fashion...
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Coding a 27446 seems to be the only code I can apply, but the doctor is pushing for me to code the removal of the loose cartilage and microfracture. I feel that both are inclusive to the 27446. Any suggestions?
Thanks,
1. Rt patellofemoral medial compartmental arthroplasty with MAKO components.
2. Removal of cartilaginous loose body.
3. Microfracture, medial femoral condyle x2.
DX:
1. Patellofemoral arthritis, particularly patella more than trochlear groove with 1 x 2-cm carilage loose body and a 1.5mm x 3-mm grade IV lesion, medial femoral condyle.
Procedure:
... Anterior skin incision was made along just medial to the tibial tubercle to the suprapatellar pouch area about 14cm. Dissection continued .... over the quadriceps. Medial arthrotomy was performed revealing a significant effusion and some synovitis. Synovectomy was accomplished around the patella. Care was taken to protect the anterior horn of the medial meniscus. ACL was intact. Grade III and IV lesions of the patella were noted. The trochlear groove was less involved, however. There was a small 1.5 x 3-mm grade IV lesion in the medial femoral condyle, but there were a much larger cartilaginous loose body in the notch than could be seen from the donor area, more likely the patella. This was a 1 x 2cm cartilaginous loose body, and this was removed. Using an Army-Navy, the remaining part of the joint was inspected, and the lateral compartment was normal.
Attention was now turned to the patella. It was templated to be a 32 and measure about 20mm or so in thickness. The saw guide was a little bulky and therefore free hand with Lahey clamps was accomplished, maintaining 12-13 mm thickness. Three holes were drilled for a 32 and then the 32 trial was placed, still measuring about a 21-mm patellar thickness with excellent patellar tracking. Trial component was removed, and the bone surfaces were prepared for cement fixation. After adequate suction and drying, the Palacos cement was mixed, appropriate consistency was reached. The cement was placed first in the trochlear groove and the femoral component was impacted. Excess cement was removed. In like fashion, the bone surface of the patella was prepared. Cement was placed and the patella button was placed, clamped into place and warm saline was used to accelerate cement hardening. After adequate hardening of the cement, the tourniquet was deflated at 34 minutes. No significant bleeders, except around the fat pad were encountered and were easily controlled with electrocautery. Further irrigation was used and then the medial arthrotomy was closed with a 0 PDS in interrupted figure-of-eight fashion and then a #1 Vicryl in running fashion...
*************
Coding a 27446 seems to be the only code I can apply, but the doctor is pushing for me to code the removal of the loose cartilage and microfracture. I feel that both are inclusive to the 27446. Any suggestions?
Thanks,