jamiepeters
Networker
I am having a problem with correct coding of a biodegradable type knee spacer removal and then reinserting a new spacer. The CPT codes are add on codes for both the removal and the insert so we can't use both of those codes (20704 and 20705) so the only other thought was using 20680 with 20704 but that just didn't feel right either. Please help if anyone has any thoughts on this or has come across the same situation. I have included the OP report below. Thank you in advance.
Operation: Procedure(s):
IRRIGATION AND DEBRIDEMENT TOTAL KNEE; WASH OUT WITH POLY EXCHANGE
Procedure: Patient was taken to the operating room and after adequate general anesthetic was administered a pneumatic tourniquet was placed about the left thigh. Left lower extremity was then prepared with Betadine and DuraPrep and draped in a sterile fashion. Antibiotics were held until definitive cultures could be obtained. IV tranexamic acid was provided. Pneumatic tourniquet was inflated to 300 mmHg following sterile draping.
The previous incisional scar was followed about the anterior left knee. Dissection was carried down sharply through skin and subcutaneous tissue to expose the quadriceps. Medial parapatellar incision was then performed. A significant joint effusion was noted with a somewhat cloudy serous fluid obtained. Cultures were obtained as well as tissue for cultures. The wound was then thoroughly irrigated with Betadine solution x3 L. Curetting of the synovial lining was performed. Exposure was provided w/ the assistant retracting. The previously placed tibial spacer was removed. Further debridement and irrigation were performed in the posterior recesses. No significant fibrous or soft tissue was encountered. Following careful irrigation and debridement with a curette and rongeur, trial spacers were again positioned. The Smith and Nephew 18 mm posterior stabilized articular implant was implanted. This provided excellent stability throughout range of motion. The wounds were again irrigated with copious saline. Hemovac was placed in the depth of the wound. Medial parapatellar incision was then closed with #1 PDS sutures. A 2-0 PDS was used for closure of the subcutaneous tissues and the skin was closed with a 2-0 nylon suture in a subcuticular fashion. Mastisol and Steri-Strips were applied. Sterile dressings were applied. The patient was taken from the operative room in good condition, tolerating the procedure and anesthesia well
Operation: Procedure(s):
IRRIGATION AND DEBRIDEMENT TOTAL KNEE; WASH OUT WITH POLY EXCHANGE
Procedure: Patient was taken to the operating room and after adequate general anesthetic was administered a pneumatic tourniquet was placed about the left thigh. Left lower extremity was then prepared with Betadine and DuraPrep and draped in a sterile fashion. Antibiotics were held until definitive cultures could be obtained. IV tranexamic acid was provided. Pneumatic tourniquet was inflated to 300 mmHg following sterile draping.
The previous incisional scar was followed about the anterior left knee. Dissection was carried down sharply through skin and subcutaneous tissue to expose the quadriceps. Medial parapatellar incision was then performed. A significant joint effusion was noted with a somewhat cloudy serous fluid obtained. Cultures were obtained as well as tissue for cultures. The wound was then thoroughly irrigated with Betadine solution x3 L. Curetting of the synovial lining was performed. Exposure was provided w/ the assistant retracting. The previously placed tibial spacer was removed. Further debridement and irrigation were performed in the posterior recesses. No significant fibrous or soft tissue was encountered. Following careful irrigation and debridement with a curette and rongeur, trial spacers were again positioned. The Smith and Nephew 18 mm posterior stabilized articular implant was implanted. This provided excellent stability throughout range of motion. The wounds were again irrigated with copious saline. Hemovac was placed in the depth of the wound. Medial parapatellar incision was then closed with #1 PDS sutures. A 2-0 PDS was used for closure of the subcutaneous tissues and the skin was closed with a 2-0 nylon suture in a subcuticular fashion. Mastisol and Steri-Strips were applied. Sterile dressings were applied. The patient was taken from the operative room in good condition, tolerating the procedure and anesthesia well