djreiff
Contributor
Can anyone help me with coding for this surgery? I'm very stuck and the codes the doctor wrote down do not seem to match what was actually done.
Thank you in advance!
PREOPERATIVE DIAGNOSIS:
Left knee patella chondral defects secondary to patella subluxation episode.
POSTOPERATIVE DIAGNOSIS:
Left knee patella chondral defects secondary to patella subluxation episode.
PROCEDURE:
Left knee arthroscopy with:
1. Patella microfracture and BioCartilage.
2. Medial patellofemoral ligament repair.
FINDINGS:
EXAM UNDER ANESTHESIA: She had full extension. No hyperextension of significant. Has 130 degrees of flexion. No
increased opening at 0 and 30 degrees with varus and valgus stress testing. Negative Lachman. Patella tracked well. She had +2
lateral glide, +1 medial glide. We could not sublux the patella laterally. It remained in the groove throughout flexion and extension.
INDICATIONS:
The patient is a young lady who injured her knee in February 2017 while playing volleyball. Her patella subluxed. She
was seen in our office. MRI and x-ray were obtained. She has a large chondral defect of the patella in 2 fragments. Arthroscopy was
performed in February 2017. We removed the 2 fragments. We did a chondroplasty. We obtained a Carticel biopsy. She has rehab
and recovered from the arthroscopy. We were going to proceed with stage II Carticel implantation; however, her insurance denied it.
As such, we have moved on to other cartilage regeneration options. They have elected to proceed with microfracture and
BioCartilage. We discussed the risks, benefits, and potential complication of this. We discussed postop rehabilitation. We discussed
reasonable expectations.
DESCRIPTION OF PROCEDURE:
The patient was admitted to Surgery Center on May 15, 2017. She was taken to holding area and properly identified. She
was administered a dose of antibiotics via IV preoperatively. She was taken to the operating room, administered general anesthesia,
placed in a supine position. All bony prominences were well padded. The left knee was examined as above. A well-padded
pneumatic tourniquet device placed around the left thigh. The left leg was then prepped and draped in the usual sterile fashion. We
used Ioban draping. We infiltrated our incision site with 0.25% Marcaine and dilute epinephrine. We exsanguinated the leg with an
Esmarch, inflated tourniquet to 300 mmHg. A midline incision was made over the patella. Skin flaps were elevated. Self-retaining
retractors were placed. We then did a medial parapatellar arthrotomy. We did identify the medial patellofemoral ligament also while
in this dissection. The patella was placed in the lateral gutter. We examined the trochlea. There was some small chondromalacia on
the far lateral aspect, not in the articulating or weightbearing portion. We then everted the patella. The underlying defect that we had
seen in arthroscopy was identified. There had been some fibrocartilage regrowth. This ended up measuring about 3 x 1 cm, 3 cm
from medial to lateral and 1 cm from superior to inferior. We used a curette and removed any nonviable cartilage in this area. This
was a contained defect. We did use the curette also to do some debridement of the calcified layer onto the bone. At this point, the
patient's blood had been drawn. We had prepared ACP to mix with our BioCartilage. The BioCartilage was opened and the ACP
mixed with this. We then did a microfracture of the patella using the Stryker drill, placed holes about every 3 mm apart. We irrigated
the area, examined it. We were satisfied with our microfracture. We then covered the area with BioCartilage, staying just below the
cartilage layer. We then covered this with the Tisseel glue. This was allowed to set up for about 6 to 7 minutes. The wound was
irrigated with copious amounts of saline solution. We then relocated the patella. We then identified our medial patellofemoral
ligament and did a suturing of this with 0 Vicryl to repair this. We then closed the medial parapatellar arthrotomy wound with 0
Vicryl figure-of-8 sutures. Subcutaneous with 2-0 Vicryl suture. It should be noted that we injected the remaining ACP into the knee
joint. The skin was closed using staples. We injected Marcaine in the wound. A nonadherent sterile dressing was applied along with
cold therapy device and knee brace locked in extension.
Thank you in advance!
PREOPERATIVE DIAGNOSIS:
Left knee patella chondral defects secondary to patella subluxation episode.
POSTOPERATIVE DIAGNOSIS:
Left knee patella chondral defects secondary to patella subluxation episode.
PROCEDURE:
Left knee arthroscopy with:
1. Patella microfracture and BioCartilage.
2. Medial patellofemoral ligament repair.
FINDINGS:
EXAM UNDER ANESTHESIA: She had full extension. No hyperextension of significant. Has 130 degrees of flexion. No
increased opening at 0 and 30 degrees with varus and valgus stress testing. Negative Lachman. Patella tracked well. She had +2
lateral glide, +1 medial glide. We could not sublux the patella laterally. It remained in the groove throughout flexion and extension.
INDICATIONS:
The patient is a young lady who injured her knee in February 2017 while playing volleyball. Her patella subluxed. She
was seen in our office. MRI and x-ray were obtained. She has a large chondral defect of the patella in 2 fragments. Arthroscopy was
performed in February 2017. We removed the 2 fragments. We did a chondroplasty. We obtained a Carticel biopsy. She has rehab
and recovered from the arthroscopy. We were going to proceed with stage II Carticel implantation; however, her insurance denied it.
As such, we have moved on to other cartilage regeneration options. They have elected to proceed with microfracture and
BioCartilage. We discussed the risks, benefits, and potential complication of this. We discussed postop rehabilitation. We discussed
reasonable expectations.
DESCRIPTION OF PROCEDURE:
The patient was admitted to Surgery Center on May 15, 2017. She was taken to holding area and properly identified. She
was administered a dose of antibiotics via IV preoperatively. She was taken to the operating room, administered general anesthesia,
placed in a supine position. All bony prominences were well padded. The left knee was examined as above. A well-padded
pneumatic tourniquet device placed around the left thigh. The left leg was then prepped and draped in the usual sterile fashion. We
used Ioban draping. We infiltrated our incision site with 0.25% Marcaine and dilute epinephrine. We exsanguinated the leg with an
Esmarch, inflated tourniquet to 300 mmHg. A midline incision was made over the patella. Skin flaps were elevated. Self-retaining
retractors were placed. We then did a medial parapatellar arthrotomy. We did identify the medial patellofemoral ligament also while
in this dissection. The patella was placed in the lateral gutter. We examined the trochlea. There was some small chondromalacia on
the far lateral aspect, not in the articulating or weightbearing portion. We then everted the patella. The underlying defect that we had
seen in arthroscopy was identified. There had been some fibrocartilage regrowth. This ended up measuring about 3 x 1 cm, 3 cm
from medial to lateral and 1 cm from superior to inferior. We used a curette and removed any nonviable cartilage in this area. This
was a contained defect. We did use the curette also to do some debridement of the calcified layer onto the bone. At this point, the
patient's blood had been drawn. We had prepared ACP to mix with our BioCartilage. The BioCartilage was opened and the ACP
mixed with this. We then did a microfracture of the patella using the Stryker drill, placed holes about every 3 mm apart. We irrigated
the area, examined it. We were satisfied with our microfracture. We then covered the area with BioCartilage, staying just below the
cartilage layer. We then covered this with the Tisseel glue. This was allowed to set up for about 6 to 7 minutes. The wound was
irrigated with copious amounts of saline solution. We then relocated the patella. We then identified our medial patellofemoral
ligament and did a suturing of this with 0 Vicryl to repair this. We then closed the medial parapatellar arthrotomy wound with 0
Vicryl figure-of-8 sutures. Subcutaneous with 2-0 Vicryl suture. It should be noted that we injected the remaining ACP into the knee
joint. The skin was closed using staples. We injected Marcaine in the wound. A nonadherent sterile dressing was applied along with
cold therapy device and knee brace locked in extension.