Orthopedic Coding Alert

Use our operative note example below to guide your code selection for an arthroscopic repair of the tibial spine fracture.

Example: "After establishing visualization through the standard anterolateral portal, we examined the intraarticular notch, patellofemoral compartment, and medial and lateral compartments to establish the extent of injury. We then established an anteromedial portal and probed the tibial spine fragment to ascertain the displacement, comminution, and soft tissue involvement. The relationship of the medial meniscus, lateral meniscus, and intermeniscal ligament was then determined with respect to the fracture fragments. The articular involvement was confirmed in the medical compartment and the amount of ecchymosis and attenuation of the ACL was ascertained.

We then debrided the hematoma and the loose fragments from the fracture base using a motorized shaver. Using a blunt trocar, we reduced the fracture and held it provisionally using a percutaneous 0.062-in Kirschner wire with the knee at 90 degrees of flexion through a medial parapatellar location.

Following this, we placed the ACL tibial guide through the anteromedial portal at a steep angle of 60 degrees and reduced the tibial spine fragment. After establishing appropriate intraarticular position of the guide, we made a 1-cm incision over the proximal anteromedial tibia and secured the extraarticular portion of the ACL tibial guide at the anterior tibial cortex.

We subsequently penetrated the fracture with the guide pin. With the drill guide held in place, we passed a 26 gauge wire bent in half through it into the knee. After removing the tibial guide we retrieved the wire out of the accessory anteromedial portal. Subsequently, we passed a No. 5 Ethibond suture through the eyelet of the wire and out the anteromedial tibia. The No. 5 Ethibond suture was passed through the ACL substance. We then established an accessory anterolateral portal lateral and superior to the anterolateral portal and passed a No. 0 nylon from the accessory anterolateral portal through the ACL substance and retrieved it through the accessory anteromedial portal. We tied the No. 0 nylon suture to the No. 5 Ethibond, passing the Ethibond through the ACL substance and then out the accessory anterolateral portal. We placed the ACL guide back in the knee through through the anteromedial portal, and secured the fracture fragments 1 to 1.5 cm from the previous drill..........................................

Once the fragments were stabilized, we again inspected the knee arthroscopically and confirmed the fracture reduction and stability by probing and placing the knee through 0 to 90 degrees of range of motion.........."

What to report: In this scenario, you confirm the arthroscopic aided repair of the intercondylar spines in the knee. You will report code 29850 (Arthroscopically aided treatment of intercodylar spine[s] and/or tuberosity fracture[s] of the knee, with or without manipulation; without internal or external fixation [includes arthroscopy]).

Tip: When your surgeon does an internal fixation, you report 29851 (Arthroscopically aided treatment of intercondylar spine[s] and/or tuberosity fracture[s] of the knee, with or without manipulation; with internal or external fixation [includes arthroscopy]).