skorkfranks
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I came up with 27446 and 27438 (this code is mutually exclusive so I'm not sure if it can be billed). Am I even in the ballpark?
OP note states:
POSTOPERATIVE DIAGNOSES: Degenerative arthritis of the right knee followingfailed conservative treatment including arthroscopy. Indication is to relieve pain and improve function.
OPERATION: Bicompartmental resurfacing of the knee.
PROCEDURE IN DETAIL: Through a standard midline incision, the knee was approached via standard median parapatellar approach to the knee. There was gross significant effusion within the knee. There was significant cartilage loss of the trochlea, patella, and medial compartment as seen on arthroscopy. Lateral compartment again showed no chondral lesions. ACL and PCL were intact. At
this point, because of the young age, I discussed preoperatively. We decided to proceed with bicompartmental resurfacing. Using the tibial cutting guide, the medial and heavy tibia was cut in the standard fashion. Sized to accept a size 3 DePuy unicondylar tibial component with a 7 mm flexion and extension gap to be balanced in flexion and extension. The distal femoral cutter was
used to prepare the distal femur. The rotation was linked to the tibial cut. The distal femoral zig was placed. The rotation was set and determined by the spacer blocks. Plug holes, posterior cut chamfers were cut in standard fashion. Attention was then turned to the tibia. Tibia was prepared to accept a size 3 tibial base plate. Lug and Quill were punched. Rotation was also predetermined by the spacer block. The trials were inserted. A 7 mm insert allowed the knee to come to the easily full extension, 30 degrees mediolaterally, 60 mediolaterally, and to posteriorly and 90 degrees of flexion gravity to over 125 degrees with central tracking of the patella. Attention was then turned to the trochlea. The grade 4 changes. Pilot hole was drilled. Sized to accept a size 4 trochlear component from DePuy set and then the anterior cut was inset on to the patient's anatomy. It was
externally rotated, but it inset on to the lateral cortical rim. Attention was then turned, using the Router shot milling system. The trochlea was prepared to accept a size 4 trochlear component. Lug hole and drill holes were placed. Trials were placed. Attention was turned to the patella, the prepatellar height measured 26 mm. The patella resected to accept a size 35mm round button. Postpatellar height measured 25 mm. The trials were
inserted. Knee easily allowed to come to full extension, 30 degrees mediolaterally, 60 degrees mediolaterally, and anterior and posterior at 90 degrees, flexion gravity to 125 degrees with central tracking of the patella using no thumbs test. The trials were removed. The joint was copiously irrigated. Tibial component was first cemented and placed, followed by the
femoral component. All excess cement was removed including from the posterior aspect of the femur. The 7 mm insert was inserted. The knee was brought to full extension and axially loaded. The trochlea component was also cemented in. Transition cells were paid tension in order to allow for no step-offs. Patella cemented in standard fashion. Upon hardening of the cement, the knee
showed excellent stability in full extension, 30 degrees mediolateral, 60 degrees mediolateral interface and 90 degrees of flexion gravity to over 100/125 degrees with central tracking of the patella using no thumbs test. The tourniquet was let down. Hemostasis obtained. The extensor mechanism was closed over single drain using #0-Vicryl with interrupted fashion, followed by
2-0 Vicryl, and staples. A sterile compressive dressing was applied. The patient tolerated the procedure well.
Thanks. Sorry for the lenghty note.
OP note states:
POSTOPERATIVE DIAGNOSES: Degenerative arthritis of the right knee followingfailed conservative treatment including arthroscopy. Indication is to relieve pain and improve function.
OPERATION: Bicompartmental resurfacing of the knee.
PROCEDURE IN DETAIL: Through a standard midline incision, the knee was approached via standard median parapatellar approach to the knee. There was gross significant effusion within the knee. There was significant cartilage loss of the trochlea, patella, and medial compartment as seen on arthroscopy. Lateral compartment again showed no chondral lesions. ACL and PCL were intact. At
this point, because of the young age, I discussed preoperatively. We decided to proceed with bicompartmental resurfacing. Using the tibial cutting guide, the medial and heavy tibia was cut in the standard fashion. Sized to accept a size 3 DePuy unicondylar tibial component with a 7 mm flexion and extension gap to be balanced in flexion and extension. The distal femoral cutter was
used to prepare the distal femur. The rotation was linked to the tibial cut. The distal femoral zig was placed. The rotation was set and determined by the spacer blocks. Plug holes, posterior cut chamfers were cut in standard fashion. Attention was then turned to the tibia. Tibia was prepared to accept a size 3 tibial base plate. Lug and Quill were punched. Rotation was also predetermined by the spacer block. The trials were inserted. A 7 mm insert allowed the knee to come to the easily full extension, 30 degrees mediolaterally, 60 mediolaterally, and to posteriorly and 90 degrees of flexion gravity to over 125 degrees with central tracking of the patella. Attention was then turned to the trochlea. The grade 4 changes. Pilot hole was drilled. Sized to accept a size 4 trochlear component from DePuy set and then the anterior cut was inset on to the patient's anatomy. It was
externally rotated, but it inset on to the lateral cortical rim. Attention was then turned, using the Router shot milling system. The trochlea was prepared to accept a size 4 trochlear component. Lug hole and drill holes were placed. Trials were placed. Attention was turned to the patella, the prepatellar height measured 26 mm. The patella resected to accept a size 35mm round button. Postpatellar height measured 25 mm. The trials were
inserted. Knee easily allowed to come to full extension, 30 degrees mediolaterally, 60 degrees mediolaterally, and anterior and posterior at 90 degrees, flexion gravity to 125 degrees with central tracking of the patella using no thumbs test. The trials were removed. The joint was copiously irrigated. Tibial component was first cemented and placed, followed by the
femoral component. All excess cement was removed including from the posterior aspect of the femur. The 7 mm insert was inserted. The knee was brought to full extension and axially loaded. The trochlea component was also cemented in. Transition cells were paid tension in order to allow for no step-offs. Patella cemented in standard fashion. Upon hardening of the cement, the knee
showed excellent stability in full extension, 30 degrees mediolateral, 60 degrees mediolateral interface and 90 degrees of flexion gravity to over 100/125 degrees with central tracking of the patella using no thumbs test. The tourniquet was let down. Hemostasis obtained. The extensor mechanism was closed over single drain using #0-Vicryl with interrupted fashion, followed by
2-0 Vicryl, and staples. A sterile compressive dressing was applied. The patient tolerated the procedure well.
Thanks. Sorry for the lenghty note.