Hi list I need the " experts " to weigh in am I coding this correctly as 29876-lt and 29879-lt?
TIA<
MB,CCS,CPC
PREOPERATIVE DIAGNOSES:
Left knee pain, synovitis, internal derangement, arthritis and
chronic pain.
POSTOPERATIVE DIAGNOSES:
Left knee pain, synovitis and arthritis, chondromalacia
abundant scar and chondromalacia of the medial joint and bone
spurs with significant scar tissue noted.
PROCEDURE:
Arthroscopic examination with synovectomy and debridement of
scar in all compartments and abrasion arthroplasty of the
medial femoral condyle and the patellofemoral area.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
BRIEF CLINICAL HISTORY:
This is a 42-year-old black male with history of a previous
injury to his knee and multiple surgeries including ACL
reconstruction. He has had several debridements of the knee
and actually get it debrided periodically and had Synvisc
injections done, which lasted for over a year. He is quite
active and rides mountain bikes and works out at the gym
regularly. He has had gradually worsening pain and options of
continued conservative care versus arthroscopic examination
and debridement were discussed with him at length. He
requests surgical treatment.
DESCRIPTION OF PROCEDURE:
After taking informed consent, the patient was brought to the
operating room table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed on left
proximal thigh. Time-out was performed. The patient was
identified, appropriate biopsy site had been marked and he
received appropriate antibiotics. Next, the skin was prepped
and 0.5% lidocaine with epinephrine was placed into the knee
joint. The left leg was then sterilely prepped and draped in
a routine manner. An anterolateral arthroscopy portal was
then made and arthroscopic examination was done. The knee was
noted to be quite tight, there was abundant scar tissue and
actually it was difficult to place the scope into the knee
joint. He was placed into the anterior portion of the knee
and the notch area and the joint was examined. There was
abundant scar tissue in this area. The ACL reconstruction
appeared to be intact. There was scarring though in the
notch. An anteromedial portal was made with the aid of a
spinal needle and the area was exposed and it had to be
debrided in order to visualize the rest of the joint. There
was a scar down loose body, which was removed also. The notch
area was thoroughly debrided with ACL and PCL intact and
removing the scar tissue in this area. The scar tissue noted
along the medial and lateral joint also was debrided with
large and small shaver and with the aid of cautery. The
articular surface showed exposed subchondral bone and this was
debrided with a shaver down to bleeding bone. It was elected
not to do microfracture but it was debrided with the shaver
because of the location. There was some bone spurs noted also
mediolaterally which were debrided. The menisci were probed.
There was some fraying *** edge of meniscus, but the
remaining portions were stable. There was some suture
material from some type of repair we had done long time ago
and this was debrided also. The patellofemoral joint showed
some areas of subcondylar bone. These were abraded with the
shaver also down to bleeding bone. Abrasion chondroplasty was
done on the patella and in the medial joint there was also
area of chondromalacia noted on the lateral femoral condyle
and this was debrided. Both gutters in the suprapatellar area
of the anterior joints and notch area were thoroughly debrided
removing extensive scar tissue. Once the scar tissue was
debrided, the knee was better visualized, but again inflamed
synovium and scar tissue throughout the knee. The surgery
took over an hour to debride the joint. *** debridement was
performed. Remainder of the exam was otherwise unremarkable.
Adequate abrasion chondroplasty and abrasion arthroplasty was
done along with the debridement and synovectomy.
Next, the arthroscopy equipment was removed from the knee.
Nylon suture used to approximate the skin edges and the
portals and joints were infiltrated with 1% lidocaine. A
sterile dressing was applied, and the patient was transferred
to the recovery in stable condition
TIA<
MB,CCS,CPC
PREOPERATIVE DIAGNOSES:
Left knee pain, synovitis, internal derangement, arthritis and
chronic pain.
POSTOPERATIVE DIAGNOSES:
Left knee pain, synovitis and arthritis, chondromalacia
abundant scar and chondromalacia of the medial joint and bone
spurs with significant scar tissue noted.
PROCEDURE:
Arthroscopic examination with synovectomy and debridement of
scar in all compartments and abrasion arthroplasty of the
medial femoral condyle and the patellofemoral area.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
BRIEF CLINICAL HISTORY:
This is a 42-year-old black male with history of a previous
injury to his knee and multiple surgeries including ACL
reconstruction. He has had several debridements of the knee
and actually get it debrided periodically and had Synvisc
injections done, which lasted for over a year. He is quite
active and rides mountain bikes and works out at the gym
regularly. He has had gradually worsening pain and options of
continued conservative care versus arthroscopic examination
and debridement were discussed with him at length. He
requests surgical treatment.
DESCRIPTION OF PROCEDURE:
After taking informed consent, the patient was brought to the
operating room table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed on left
proximal thigh. Time-out was performed. The patient was
identified, appropriate biopsy site had been marked and he
received appropriate antibiotics. Next, the skin was prepped
and 0.5% lidocaine with epinephrine was placed into the knee
joint. The left leg was then sterilely prepped and draped in
a routine manner. An anterolateral arthroscopy portal was
then made and arthroscopic examination was done. The knee was
noted to be quite tight, there was abundant scar tissue and
actually it was difficult to place the scope into the knee
joint. He was placed into the anterior portion of the knee
and the notch area and the joint was examined. There was
abundant scar tissue in this area. The ACL reconstruction
appeared to be intact. There was scarring though in the
notch. An anteromedial portal was made with the aid of a
spinal needle and the area was exposed and it had to be
debrided in order to visualize the rest of the joint. There
was a scar down loose body, which was removed also. The notch
area was thoroughly debrided with ACL and PCL intact and
removing the scar tissue in this area. The scar tissue noted
along the medial and lateral joint also was debrided with
large and small shaver and with the aid of cautery. The
articular surface showed exposed subchondral bone and this was
debrided with a shaver down to bleeding bone. It was elected
not to do microfracture but it was debrided with the shaver
because of the location. There was some bone spurs noted also
mediolaterally which were debrided. The menisci were probed.
There was some fraying *** edge of meniscus, but the
remaining portions were stable. There was some suture
material from some type of repair we had done long time ago
and this was debrided also. The patellofemoral joint showed
some areas of subcondylar bone. These were abraded with the
shaver also down to bleeding bone. Abrasion chondroplasty was
done on the patella and in the medial joint there was also
area of chondromalacia noted on the lateral femoral condyle
and this was debrided. Both gutters in the suprapatellar area
of the anterior joints and notch area were thoroughly debrided
removing extensive scar tissue. Once the scar tissue was
debrided, the knee was better visualized, but again inflamed
synovium and scar tissue throughout the knee. The surgery
took over an hour to debride the joint. *** debridement was
performed. Remainder of the exam was otherwise unremarkable.
Adequate abrasion chondroplasty and abrasion arthroplasty was
done along with the debridement and synovectomy.
Next, the arthroscopy equipment was removed from the knee.
Nylon suture used to approximate the skin edges and the
portals and joints were infiltrated with 1% lidocaine. A
sterile dressing was applied, and the patient was transferred
to the recovery in stable condition