Pt had a knee revision done on 9/9/2008 and now has a dislocation of this prosthesis.
op report shows
postoperative diagnosis: dislocation of hinged contraint or revision rt knee
surigcal procedure: open reduction and irrigation, debridement of rt knee dislocation.
An incision made directly over the old scar from the superior mid to superior portion of patella down to inferior edge through skin, subcu and on entire sheath was taken. These sutures were identified in the fascia and a paramedian approach to the old incision was then performed. At that point in time, the knee was clearly dislocated. There was no evidence of purulent drainage, but old hematoma which had already turned serous and fluid and was already in an organized clot-type fashion indicating this hematoma had been present for several days.
At that point in time, the knee could be clearly seen to be dislocated of the articulated polyethylene spacer from the tibia. No evidence of fracture or instability of prosthesis was noted. the knee was hyperflexed to put the foot against the pt's back of the thigh. A bone hook used and the distal tip, after much manipulation, was gently impacted back into the tibial area. Once the are was reduced, the pt was able to extend to within 5 degrees of extension and flex without any evidence of instability. All organized hematoma were removed and no evidence of infection noted. All bone surfaces were stable on reprobe.
**Dr wants to bill 27556 but can this be used for a dislocated prosthesis or should I use the unlisted code?
Any thoughts would be greatly appreciated!
Cathy
op report shows
postoperative diagnosis: dislocation of hinged contraint or revision rt knee
surigcal procedure: open reduction and irrigation, debridement of rt knee dislocation.
An incision made directly over the old scar from the superior mid to superior portion of patella down to inferior edge through skin, subcu and on entire sheath was taken. These sutures were identified in the fascia and a paramedian approach to the old incision was then performed. At that point in time, the knee was clearly dislocated. There was no evidence of purulent drainage, but old hematoma which had already turned serous and fluid and was already in an organized clot-type fashion indicating this hematoma had been present for several days.
At that point in time, the knee could be clearly seen to be dislocated of the articulated polyethylene spacer from the tibia. No evidence of fracture or instability of prosthesis was noted. the knee was hyperflexed to put the foot against the pt's back of the thigh. A bone hook used and the distal tip, after much manipulation, was gently impacted back into the tibial area. Once the are was reduced, the pt was able to extend to within 5 degrees of extension and flex without any evidence of instability. All organized hematoma were removed and no evidence of infection noted. All bone surfaces were stable on reprobe.
**Dr wants to bill 27556 but can this be used for a dislocated prosthesis or should I use the unlisted code?
Any thoughts would be greatly appreciated!
Cathy
