Setting aside the discussion on conversion, I think we would have to see the op report to be sure. Did he make an open incision and do the arthrotomy and complete the ACL repair in an open fashion. Was the implant placement and work done through one of the stab/portal holes? Was there anything else done like the meniscus? Doesn't ACL repair always require an arthrotomy since it's intr-articular?
I would probably code 29888 in this case.
Here is a copy of the procedure. I really appreciate your inputs!
DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was taken to the operating room and general anesthetic and adductor canal block administered. Left leg was examined under anesthesia, positive pivot shift, positive anterior drawer and Lachman's. Leg was prepped and draped in normal sterile fashion. Leg was exsanguinated, tourniquet inflated to 300 mmHg. Anterolateral and anteromedial arthroscopic portals were established. Systematic arthroscopic examination of the knee was carried out. Inspection of the notch revealed a complete tear of the ACL with a stump remaining on the tibial portion. The PCL was intact. The anterior compartment revealed no pathology. The medial compartment revealed a meniscal capsular separation at the junction of posterior horn and middle portion of the medial meniscus. The lateral compartment demonstrated that he had a tear of the white to the white-red zone far posterior to the popliteal hiatus.
At this point, meticulous care was taken to clean up the lateral meniscal tear. Initially, it was attempted to do a suture through this to see if it was repairable, but the suture pulled through because the tissue was really too thin on the meniscal portion that was torn, and the Mitek anchor was removed, and the partial lateral meniscectomy was carried out, smoothing this back to a stable articular rim. Inspection of the medial compartment revealed the meniscocapsular junction had been disrupted. A rasp was used to clean this up to create a bleeding surface and then, once this was done, 2 horizontal mattress sutures with Mitek TrueSpan meniscal repair kit were done, placed them on the inferior portion of the meniscus working posteriorly and then medially, obtaining anatomic fixation of the medial meniscal tear. Next, a very small notchplasty was carried out in the notch, and then, utilizing a PassPort cannula in the medial portal, a FiberLink was used to pass alternating sutures, medial to lateral to medial and the medial to lateral through the stump of the tissue and then the knee was flexed and just anterior to the footprint, a pilot hole was punched for the anchor, and the SwiveLock anchor was loaded with 2 FiberWire sutures plus the FiberLink from the stump of the ACL, and it was placed in the femoral side and seated appropriately. The sutures were then docked through an accessory portal medially and once this was done, and the drill hole through the tibia was made bringing this up just anterior to the ACL stump and then the sutures were pulled out and locked through an accessory medial portal, and an arthrotomy was then performed. Once this was done, the bare implant was opened, and it was hydrated with the patient's blood after passing the sutures from the anchor down through this in 4 different quadrants and then passing the suture tails down out through the tibial tunnel. Once it was appropriately hydrated, the BEAR implant, after doing the arthrotomy, the knee was opened, and the BEAR implant was then introduced through the open arthrotomy, and this was this was placed in line with the fibers of the ACL stump all the way up to the lateral wall. Per technique, bringing the knee out to extension. The sutures were tensioned through the tibial tunnel and repaired with a 4.75 mm SwiveLock anchor. The knee was kept in full extension the remainder of the course, and the arthrotomy was closed with 0 Ethibond in interrupted fashion, 2-0 Vicryl and staples were applied to the skin. Sterile dressing was applied. He was taken to Recovery in stable condition. There were no known complications.