caitlin.ski2011@gmail.com
Contributor
Provider states he did 27447- knee arthroplasty but also a distal femur replacement Arthroplasty (is this a thing?), allograft tissue implant and large fragment bone excision but I'm struggling with what to code. Any help would be appreciated
DESCRIPTION OF PROCEDURE: On the day of the operative procedure, the patient was positively identified in the preoperative holding area by the operative provider and surgical site was signed and marked. He was taken back to the OR, placed supine on a well-padded OR table and after induction of anesthesia, the correct lower extremity was prepped and draped in the usual sterile fashion after a timeout was performed, the case was initiated. A standard midline incision was made with a 10 blade. Full-thickness flaps were elevated medially and laterally. Medial parapatellar arthrotomy was made and the patella was then everted and a freehand cut was then made, it was sized for a 35x9 patellar button, it was drilled and a metal cover was placed to protect this. Next, attention was then drawn to the femur. The intra-articular femoral condylar split and distal femoral fragment was then excised circumferentially, after wide excision of this, taking care to avoid injury to the neurovascular structures, they were passed off the back table to be sized. Once this had been completed, attention was then drawn to the freshening cut and it was measured, marked for both rotation and for length of cut before removing the distal femoral placed previously using the Bovie on the distal femur, it was grasped with the bone holding forceps and it was then cut at the 7cm mark. Next, the canal was prepared. A canal restrictor was placed. Decision was made to go with a 90mm stem as opposed to 150. Based upon the fact that this patient had previously placed cephalomedullary nail, we did not want to create a stress riser. Once this had been thoroughly prepared and the canal restrictor then applied, the trial was then inserted. Attention was then drawn to the tibia where an intramedullary guide was then placed into the tibia and a cut was then made, taking 12mm off the high side to account for and accommodate the 12mm minimum poly thickness needed. Next, the canal was prepared and broached and the trial was then pinned into place. With the trial pinned into place, it was then taken through a range of motion and found to have appropriate fit and fill with ____ and no hyperextension. C-arm fluoroscopic images were obtained. After this had been completed, the trial instruments were all removed and it was then copiously irrigated. Cement was then pressurized into the femoral canal first by the anesthesia note and the implant was then placed and held in place while the cement was allowed to polymerize, the same was done with the tibia as well as the patellar button, it was taken through a range of motion. Final C-arm shots were taken and confirmed no change in alignment.
DESCRIPTION OF PROCEDURE: On the day of the operative procedure, the patient was positively identified in the preoperative holding area by the operative provider and surgical site was signed and marked. He was taken back to the OR, placed supine on a well-padded OR table and after induction of anesthesia, the correct lower extremity was prepped and draped in the usual sterile fashion after a timeout was performed, the case was initiated. A standard midline incision was made with a 10 blade. Full-thickness flaps were elevated medially and laterally. Medial parapatellar arthrotomy was made and the patella was then everted and a freehand cut was then made, it was sized for a 35x9 patellar button, it was drilled and a metal cover was placed to protect this. Next, attention was then drawn to the femur. The intra-articular femoral condylar split and distal femoral fragment was then excised circumferentially, after wide excision of this, taking care to avoid injury to the neurovascular structures, they were passed off the back table to be sized. Once this had been completed, attention was then drawn to the freshening cut and it was measured, marked for both rotation and for length of cut before removing the distal femoral placed previously using the Bovie on the distal femur, it was grasped with the bone holding forceps and it was then cut at the 7cm mark. Next, the canal was prepared. A canal restrictor was placed. Decision was made to go with a 90mm stem as opposed to 150. Based upon the fact that this patient had previously placed cephalomedullary nail, we did not want to create a stress riser. Once this had been thoroughly prepared and the canal restrictor then applied, the trial was then inserted. Attention was then drawn to the tibia where an intramedullary guide was then placed into the tibia and a cut was then made, taking 12mm off the high side to account for and accommodate the 12mm minimum poly thickness needed. Next, the canal was prepared and broached and the trial was then pinned into place. With the trial pinned into place, it was then taken through a range of motion and found to have appropriate fit and fill with ____ and no hyperextension. C-arm fluoroscopic images were obtained. After this had been completed, the trial instruments were all removed and it was then copiously irrigated. Cement was then pressurized into the femoral canal first by the anesthesia note and the implant was then placed and held in place while the cement was allowed to polymerize, the same was done with the tibia as well as the patellar button, it was taken through a range of motion. Final C-arm shots were taken and confirmed no change in alignment.