Sara82
Guru
Dr started arthroscopically and went to open. Dr wants to code 29877, 27405(59) and 27599(Open removal of loose body). Is this correct to code the unlisted code or should 27331(arthrotomy; removal of loose or foreign body).
POSTOPERATIVE DIAGNOSIS:
Right knee recurrent patellar instability with a very shallow trochlea,possible small loose bodies with a chondral lesion under the medial facet of the patella as well as a bone fragment medially with a medial patellofemoral ligament attached.
PROCEDURES:
1. Right knee arthroscopy. Arthroscopic chondroplasty and debridement of the
patella with removal of very small chondral fragments.
2. Open removal of a large loose body and repair of the medial patellofemoral
ligament back to the patella.
DESCRIPTION OF OPERATION:
I initially scoped his joint, which was significant
for a grade 3 chondral lesion in the medial facet of the patella. I performed
an arthroscopic chondroplasty to debride this, but it was not all the way down
to bone, and then a small area on the lateral femoral condyle was also debrided
as well for which he was recurrently dislocating. His trochlea was very
shallow. He also had some very small chondral fragments in the joint which
were removed through the shaver. His medial and lateral compartments looked
pristine. His ACL and PCL were pristine. His problem was really the center on
the patellofemoral compartment. After that was completed, I then made a 3.5 cm
medial parapatellar incision. The incision was carried down and the loose bone
fragment was easily identified. It was a nonunion and the bone fragment was
not of very good quality. Therefore, I removed the large piece of bone and
then I isolated the patellofemoral ligament with the medial retinaculum. I
used a bur to bur the medial patellar region to enhance healing and then I
placed three Arthrex labral anchors into the patella staying away from the
articular cartilage, and then excellent fixation was obtained, and then I used
them to place three Krakow-like stitches medial imbricating the medial
patellofemoral ligament and capsule, and this was repaired back to the patella,
and then I used 0 Vicryl to complete the repair. The patella was much more
stable when I was done. He is still a little bit lax though, especially with
his shallow trochlea, but I think this is a reasonable first step for him after
retensioning and repairing the ligament.
POSTOPERATIVE DIAGNOSIS:
Right knee recurrent patellar instability with a very shallow trochlea,possible small loose bodies with a chondral lesion under the medial facet of the patella as well as a bone fragment medially with a medial patellofemoral ligament attached.
PROCEDURES:
1. Right knee arthroscopy. Arthroscopic chondroplasty and debridement of the
patella with removal of very small chondral fragments.
2. Open removal of a large loose body and repair of the medial patellofemoral
ligament back to the patella.
DESCRIPTION OF OPERATION:
I initially scoped his joint, which was significant
for a grade 3 chondral lesion in the medial facet of the patella. I performed
an arthroscopic chondroplasty to debride this, but it was not all the way down
to bone, and then a small area on the lateral femoral condyle was also debrided
as well for which he was recurrently dislocating. His trochlea was very
shallow. He also had some very small chondral fragments in the joint which
were removed through the shaver. His medial and lateral compartments looked
pristine. His ACL and PCL were pristine. His problem was really the center on
the patellofemoral compartment. After that was completed, I then made a 3.5 cm
medial parapatellar incision. The incision was carried down and the loose bone
fragment was easily identified. It was a nonunion and the bone fragment was
not of very good quality. Therefore, I removed the large piece of bone and
then I isolated the patellofemoral ligament with the medial retinaculum. I
used a bur to bur the medial patellar region to enhance healing and then I
placed three Arthrex labral anchors into the patella staying away from the
articular cartilage, and then excellent fixation was obtained, and then I used
them to place three Krakow-like stitches medial imbricating the medial
patellofemoral ligament and capsule, and this was repaired back to the patella,
and then I used 0 Vicryl to complete the repair. The patella was much more
stable when I was done. He is still a little bit lax though, especially with
his shallow trochlea, but I think this is a reasonable first step for him after
retensioning and repairing the ligament.