okandy
Guest
I desperately need some help regarding whether to bill the synovectomy. Would someone please be so kind as to help code this report? The coder billed 29881 and G0289. Could she also bill for the partial synovectomy, 29875-59?
Preoperative Diagnosis: Chondrocalcinosis, right knee, with internal derangement.
Postoperative Diagnosis:
1. Chondrocalcinosis of the right knee with proliferative synovitis.
2. Torn medial meniscus, right knee.
Name of Operation:
1. Arthroscopic partial medial meniscectomy, right knee.
2. Debridement of chondrocalcinosis and synovium with partial synovectomy, right knee.
Description of Procedure: A stab wound was made superolaterally and then catheter was inserted. . . A lateral portal was made anteriorly and the scope inserted.
The scope was inserted and arthroscopic exam was begun. The patient's suprapatellar pouch had areas of scarred synovium with dense chondrocalcinosis present. Medially and following the medial recess, the patient's synovium was more proliferative and inflamed with particles of chondrocalcinosis within them. This was noted for later debridement. Entering the medial compartment, the knee was placed in a valgus configuration with leg externally rotated. This allowed visualization of the medial compartment. The patient had some softening and discoloration of the articular surfaces of the femur and the tibia. There were several small areas of punctate calcifications. The posterior horn of the meniscus was noted to have considerable chondrocalcinosis present. A third portal was made. The posterior horn of the meniscus was quite degenerative and soft. There was a bucket-handle tear which allowed displacement of the bulk of the posterior horn body into the joint. Straight basket forceps were used to morcellize this very soft meniscus material. Sucker shaver was used to remove the fragments and to smooth the rim. Probe was replaced and this cycle was done until no further displaceable posterior horn of the meniscus could be identified. Once this was completed, the notch was examined. There was a large area of calcium deposit at the base of the anterior cruciate ligament. This was broken loose with a probe and then the sucker shaver was used to remove much of the calcium material. The knee was placed in a figure 4 position and the patient had a considerable amount of very small punctate crystals on the surface of the meniscus, but no degenerative changes and no tears were found on the medial meniscus.
Following the lateral recess back to the suprapatellar pouch, attention was returned there for the partial synovectomy. The sucker shaver was placed and the proliferative synovium noted superiorly and medially was removed. Much of the crystalline deposits that were in this were removed as well. The synovial tissue laterally was more scarred. This was quite dense and the sucker shaver would bounce off this. It was felt this could be left. Patellofemoral joint was visualized and it had good articulation with minimal softening of the articular cartilage and no chondrocalcinosis present. The quick tour of the knee failed to reveal any other problems and no loose fragments of cartilage from the meniscectomy.
I appreciate any help you can provide. Thanks in advance.
Preoperative Diagnosis: Chondrocalcinosis, right knee, with internal derangement.
Postoperative Diagnosis:
1. Chondrocalcinosis of the right knee with proliferative synovitis.
2. Torn medial meniscus, right knee.
Name of Operation:
1. Arthroscopic partial medial meniscectomy, right knee.
2. Debridement of chondrocalcinosis and synovium with partial synovectomy, right knee.
Description of Procedure: A stab wound was made superolaterally and then catheter was inserted. . . A lateral portal was made anteriorly and the scope inserted.
The scope was inserted and arthroscopic exam was begun. The patient's suprapatellar pouch had areas of scarred synovium with dense chondrocalcinosis present. Medially and following the medial recess, the patient's synovium was more proliferative and inflamed with particles of chondrocalcinosis within them. This was noted for later debridement. Entering the medial compartment, the knee was placed in a valgus configuration with leg externally rotated. This allowed visualization of the medial compartment. The patient had some softening and discoloration of the articular surfaces of the femur and the tibia. There were several small areas of punctate calcifications. The posterior horn of the meniscus was noted to have considerable chondrocalcinosis present. A third portal was made. The posterior horn of the meniscus was quite degenerative and soft. There was a bucket-handle tear which allowed displacement of the bulk of the posterior horn body into the joint. Straight basket forceps were used to morcellize this very soft meniscus material. Sucker shaver was used to remove the fragments and to smooth the rim. Probe was replaced and this cycle was done until no further displaceable posterior horn of the meniscus could be identified. Once this was completed, the notch was examined. There was a large area of calcium deposit at the base of the anterior cruciate ligament. This was broken loose with a probe and then the sucker shaver was used to remove much of the calcium material. The knee was placed in a figure 4 position and the patient had a considerable amount of very small punctate crystals on the surface of the meniscus, but no degenerative changes and no tears were found on the medial meniscus.
Following the lateral recess back to the suprapatellar pouch, attention was returned there for the partial synovectomy. The sucker shaver was placed and the proliferative synovium noted superiorly and medially was removed. Much of the crystalline deposits that were in this were removed as well. The synovial tissue laterally was more scarred. This was quite dense and the sucker shaver would bounce off this. It was felt this could be left. Patellofemoral joint was visualized and it had good articulation with minimal softening of the articular cartilage and no chondrocalcinosis present. The quick tour of the knee failed to reveal any other problems and no loose fragments of cartilage from the meniscectomy.
I appreciate any help you can provide. Thanks in advance.