martnel
Guest
How would you code this, other than 29879? 27509 was mentioned... I am just not sure about this one.
PREOPERATIVE DIAGNOSIS:
Osteonecrosis, medial femoral condyle, right knee. with possible meniscal tear, osteochondral fragment.
POSTOPERATIVE DIAGNOSIS:
1. Osteonecrosis medial femoral condyle with osteochondral loose body.
2. Lateral femoral condyle insufficiency fracture.
PROCEDURE:
Knee arthroscopy with debridement of osteochondral loose body, percutaneous AccuFill injections under fluoroscopy, subchondral microfracture of medial femoral condyle.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed in the supine position on the operating table. The right lower extremity was wrapped proximally with a Webril wrap, over which a pneumatic tourniquet was placed. The limb was not secured in a thigh holder. It was prepared with isopropyl alcohol, followed by ChloraPrep, draped in usual sterile fashion for knee surgery. Bony landmarks about the knee were marked with a marking pen. Planned portal areas were infiltrated with 0.5% lidocaine with epinephrine. Through an anterolateral portal, the 30? arthroscope was inserted into the joint. Inspection of the lateral compartment revealed intact articular surfaces and normal lateral meniscus. Intercondylar notch inspection revealed normal appearing anterior and posterior cruciate ligament. Inspection of the medial condyle revealed defect in the osteochondral weight-bearing surface. This fragment was found in the anterior compartment and extracted. The rim was debrided to remove unstable hyaline cartilage. At this point, fluoroscopy was brought in. The condylar line was identified. Using AccuFill and fluoroscopy, the area of insufficiency fracture in the central portion of the lateral femoral condyle extending to the intercondylar notch was identified. 5 mL of AccuFill were placed under fluoroscopic guidance throughout the substance of the lesion. After waiting 8 to 10 minutes, attention was redirected back to the medial femoral condyle, where subchondral microfracture was carried out at 3 to 5 mm intervals. Pressure was reduced until blood flow was noted. There was no extrusion of the AccuFill material into the lesion or the joint. Instruments and Ringer's were removed from the joint. Portals were closed with 4-0 Vicryl subcutaneous suture and Dermabond wound cement was used to close the skin.
PREOPERATIVE DIAGNOSIS:
Osteonecrosis, medial femoral condyle, right knee. with possible meniscal tear, osteochondral fragment.
POSTOPERATIVE DIAGNOSIS:
1. Osteonecrosis medial femoral condyle with osteochondral loose body.
2. Lateral femoral condyle insufficiency fracture.
PROCEDURE:
Knee arthroscopy with debridement of osteochondral loose body, percutaneous AccuFill injections under fluoroscopy, subchondral microfracture of medial femoral condyle.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed in the supine position on the operating table. The right lower extremity was wrapped proximally with a Webril wrap, over which a pneumatic tourniquet was placed. The limb was not secured in a thigh holder. It was prepared with isopropyl alcohol, followed by ChloraPrep, draped in usual sterile fashion for knee surgery. Bony landmarks about the knee were marked with a marking pen. Planned portal areas were infiltrated with 0.5% lidocaine with epinephrine. Through an anterolateral portal, the 30? arthroscope was inserted into the joint. Inspection of the lateral compartment revealed intact articular surfaces and normal lateral meniscus. Intercondylar notch inspection revealed normal appearing anterior and posterior cruciate ligament. Inspection of the medial condyle revealed defect in the osteochondral weight-bearing surface. This fragment was found in the anterior compartment and extracted. The rim was debrided to remove unstable hyaline cartilage. At this point, fluoroscopy was brought in. The condylar line was identified. Using AccuFill and fluoroscopy, the area of insufficiency fracture in the central portion of the lateral femoral condyle extending to the intercondylar notch was identified. 5 mL of AccuFill were placed under fluoroscopic guidance throughout the substance of the lesion. After waiting 8 to 10 minutes, attention was redirected back to the medial femoral condyle, where subchondral microfracture was carried out at 3 to 5 mm intervals. Pressure was reduced until blood flow was noted. There was no extrusion of the AccuFill material into the lesion or the joint. Instruments and Ringer's were removed from the joint. Portals were closed with 4-0 Vicryl subcutaneous suture and Dermabond wound cement was used to close the skin.