Identify How to Report a Knee Joint Scar Excision
Question: How should I report an intra-articular scar excision? I’ve always been told to use the complex repair codes, but that doesn’t make sense to me since the excision is from inside the joint. Here is an excerpt from a current operative note for reference: Preoperative Diagnosis: 1. Painful right total knee arthroplasty 2. Arthrofibrosis right total knee arthroplasty 3. Painful patellar osteophyte right total knee arthroplasty. Description of Procedure: Utilizing his previous surgical incision was made through the skin subcutaneous tissue medial parapatellar arthrotomy was performed. There was extensive scar suprapatellar pouch of the gutters retractors were placed and a Bovie used to remove the scar tissue. I then evaluated and used a tamp to evaluate the femoral and tibial component these were both well fixed. I everted the patella removed scar tissue from around the patellar component patellar component was well fixed I dissected around the lateral patellar bone removing the osteophyte with a rongeur. Would an arthrotomy code be appropriate since the surgeon is opening the joint? Indiana Subscriber Answer: Yes, an arthrotomy code would be appropriate for an intra-articular scar excision. Based on the operative note you provided, you’ll assign 27334 (Arthrotomy, with synovectomy, knee; anterior OR posterior) to report the procedure performed. While the scar tissue is excised from inside the knee, 27334 is appropriate because an arthrotomy is a surgical incision of the joint. The surgeon used an anterior approach to the knee, which matches 27334’s descriptor. However, if the surgeon had used both anterior and posterior approaches for the same surgery, then you’d assign 27335 (… anterior AND posterior including popliteal area). Mike Shaughnessy, BA, CPC, Production Editor, AAPC
