Wiki Medial collateral ligament lengthening & bone marrow venting

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Joyce Burchett

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Does anyone know if I can use 29879 for the above procedure or should I use unlisted 29999 or would this be considered part of 29882? Has anyone heard of bone marrow venting?
Op Report: Anterolateral portal established--Patellofemoral trochlear surfaces normal as well as medial lateral gutters. Medial joint line was entered. A valgus stress was applied. We saw the radial-type tear of the posterior horn & body junction of the medial meniscus. An anteromedial portal was established parallel to tibial plateau. We noted the superior articular edge of the tear was approximately 50% whereas the undersurface tear was nearly 100% of the meniscus. We used a shaver, rasp & needle to trephinate the capsular tissues. We also used a spinal needle 18-gauge to trephinate the medial collateral ligament to allow for a medial collateral ligament lengthening procedure so that we could enter the medial compartment without damaging the articular surfaces of the medial femoral condyle or tibial plateau. We then from both the anterolateral & anteromedial portal used a Arthrex scorpion device to place vertical mattress sutures across the radial tear. The sutures were tied with sliding & locking knots with alternating half hitches & post. A total of 4 sutures were inserted. There is anatomic approximation of the medial meniscus tear. The ACL & PCL were intact. The lateral meniscus, lateral femoral condyle & tibial plateau articular surfaces were normal. We then used a 45 degree awl to perform a bone marrow venting procedure of the lateral femoral condyle just anterior to the anterior cruciate ligament insertion site. Following this the water was turned off. There was bone marrow & blood extravasating from the bone. Wounds were closed, steri-strips applied & dressings applied.
 
Hello all. I'm a Compliance Coding Auditor and reviewing an OP note that has me perplexed. I found the above question from 12/7/2017 from "ironically" my previous co-worker - she's retired now.

This has come up again recently, I don't see any replies, and the thread is from 2017 so 29879 I don't see as an active code.

The patient was scheduled for a LT Knee arthroscopic-assisted posterior root medical meniscus repair and was performed, coded as 29882.

My conundrum is:

However, they didn't code for the Medial Collateral ligament lengthening procedure, could this be because it had to be performed in conjunction with the more extensive procedure??

Can anyone shed light on this subject, especially the "We noted the superior articular edge of the tear was approximately 50% whereas the undersurface tear was nearly 100% of the meniscus. We used a shaver, rasp & needle to trephinate the capsular tissues. We also used a spinal needle 18-gauge to trephinate the medial collateral ligament to allow for a medial collateral ligament lengthening procedure so that we could enter the medial compartment without damaging the articular surfaces of the medial femoral condyle or tibial plateau."

Please help me figure this out, any assistance is GREATLY appreciative.
 
If there was no diagnosis or anything wrong with the MCL, it looks like it was more for access or done in the course of the meniscal repair. Specifically, since they state "so that we could enter the medial compartment..." There's nothing additional to code from what you have there.
I think the prior post with the word venting is not seen very often. Sometimes you see it as microfracture or bone marrow stimulation. It is done to promote a healing response in the course of the mensical repair.
It's most likely included unless there was some other reason for microfracture 29879 like maybe chondromalacia or OCD.
 
amyjph said:
If there was no diagnosis or anything wrong with the MCL, it looks like it was more for access or done in the course of the meniscal repair. Specifically, since they state "so that we could enter the medial compartment..." There's nothing additional to code from what you have there.
I think the prior post with the word venting is not seen very often. Sometimes you see it as microfracture or bone marrow stimulation. It is done to promote a healing response in the course of the mensical repair.
It's most likely included unless there was some other reason for microfracture 29879 like maybe chondromalacia or OCD.
Click to expand...
Thank you so much for the additional info, it's the way I was leaning but wanted to make sure.

Makes sense that majority of us with OCD need to vent every now and again lol, although I have CDO - it's alphabetized.

Have a great weekend!
 
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