Kestrelwa
Contributor
Hello,
How would you all code the following op report? This was has been coded a couple different ways and the payor has denied charges as not supported.
This was coded as 27486-52-RT, 27430-51-RT and denied. A corrected claim was submitted with 27430-RT, 27310-51-RT. Still denied.
Would appreciate any help you could offer in getting this surgery paid.
DESCRIPTION OF PROCEDURE:
His old total knee incision was used and dissection carried out down to and through the soft tissues to the quadriceps mechanism. The old medial parapatellar arthrotomy was entered and knee fluid was sent for cell count, differential, Gram stain, culture and intra-articular synovial for frozen section. We noted the extremely dense scarring about the knee. We began performing a complete meticulous synovectomy including removing as much of the scar tissue as possible throughout the knee. We performed a formal quadricepsplasty freeing up the quad mechanism where it was densely scarred down to the femur. We then circumferentially exposed the patellar component. It appeared to be well aligned and fixed. In my judgment, it was best served by being left in place. Again, he had extremely dense scarring about the knee, and we spent a very significant amount of time attempting to remove as much of the scar as possible. We were eventually able to flex the knee further and eventually were able to remove the tibial polyethylene. We then completed our synovectomy and continued debriding all of the heterotopic ossification and bone as much as possible about the entire knee. After we had done this, we then placed trial polys, beginning with a 12.5 mm poly and eventually felt with a 17.5 mm poly we had full complete extension, excellent flexion and stability. With this in place, we were able to flex his knee easily to 120 degrees. At this point, in my judgment, he is best served by going with this construct. Please note, we had circumferentially exposed as much of the femoral and tibial components as possible, and again they appear to be well aligned and fixed, and in my judgment, will be best served by being left in place. We irrigated. We then seated the final DePuy PFC Sigma mobile bearing TC3 polyethylene 17.5 mm thick for the size 4 component. We injected about the knee with 60 mL of 0.25 percent Marcaine with epinephrine. The tourniquet was released and hemostasis was obtained with electrocautery. A single 1/8 inch drain was placed in lateral gutter. Quadriceps mechanism was approximated using interrupted #2 Ethibond and #1 Vicryl sutures. Deep and superficial subcutaneous tissues were approximated using a 0 Quill suture and the skin was closed with running subcuticular 3-0 Stratafix suture. Dermabond was placed on the incision, followed by sterile dressing and cold therapy pad. He was taken to the recovery room in stable condition.
Thank you!!
How would you all code the following op report? This was has been coded a couple different ways and the payor has denied charges as not supported.
This was coded as 27486-52-RT, 27430-51-RT and denied. A corrected claim was submitted with 27430-RT, 27310-51-RT. Still denied.
Would appreciate any help you could offer in getting this surgery paid.
DESCRIPTION OF PROCEDURE:
His old total knee incision was used and dissection carried out down to and through the soft tissues to the quadriceps mechanism. The old medial parapatellar arthrotomy was entered and knee fluid was sent for cell count, differential, Gram stain, culture and intra-articular synovial for frozen section. We noted the extremely dense scarring about the knee. We began performing a complete meticulous synovectomy including removing as much of the scar tissue as possible throughout the knee. We performed a formal quadricepsplasty freeing up the quad mechanism where it was densely scarred down to the femur. We then circumferentially exposed the patellar component. It appeared to be well aligned and fixed. In my judgment, it was best served by being left in place. Again, he had extremely dense scarring about the knee, and we spent a very significant amount of time attempting to remove as much of the scar as possible. We were eventually able to flex the knee further and eventually were able to remove the tibial polyethylene. We then completed our synovectomy and continued debriding all of the heterotopic ossification and bone as much as possible about the entire knee. After we had done this, we then placed trial polys, beginning with a 12.5 mm poly and eventually felt with a 17.5 mm poly we had full complete extension, excellent flexion and stability. With this in place, we were able to flex his knee easily to 120 degrees. At this point, in my judgment, he is best served by going with this construct. Please note, we had circumferentially exposed as much of the femoral and tibial components as possible, and again they appear to be well aligned and fixed, and in my judgment, will be best served by being left in place. We irrigated. We then seated the final DePuy PFC Sigma mobile bearing TC3 polyethylene 17.5 mm thick for the size 4 component. We injected about the knee with 60 mL of 0.25 percent Marcaine with epinephrine. The tourniquet was released and hemostasis was obtained with electrocautery. A single 1/8 inch drain was placed in lateral gutter. Quadriceps mechanism was approximated using interrupted #2 Ethibond and #1 Vicryl sutures. Deep and superficial subcutaneous tissues were approximated using a 0 Quill suture and the skin was closed with running subcuticular 3-0 Stratafix suture. Dermabond was placed on the incision, followed by sterile dressing and cold therapy pad. He was taken to the recovery room in stable condition.
Thank you!!