We have been going back and forth amongst several coders, the provider and our coding and compliance department and none of us seem to agree on the same code to use in this case. Does anyone have any suggestions for coding this scenario? Provider says he has always billed 29873 for the lateral retinacular release and 27429 for the OPEN medial retinacular repair. We thought this might need to be coded using an unlisted code, 27599. Our QM dept suggest 27566 but then agreed with 27429 after the provider disagreed with 27566. Another coder suggested 27422. Suggestions are appreciated.
Diagnosis: Left Patellar dislocation
Procedures: Left knee arthroscopy with lateral retinacular release and open medial retinacular repair
Procedure:
patient is a 19-year-old male who had originally dislocated his patella in the eighth grade. He had a subsequent patellar dislocation recently 9/13/2025 when he fell over a cooler. Review his MRI showed that he had a patellar dislocation with injury to his medial retinaculum off of the medial aspect of the patella. We did discuss nonoperative versus operative treatments but did elect for surgical intervention. We discussed risk and benefit surgery including potential complications and time frames for recovery which he understood and agreed.
We marked the operative site in the preoperative holding area and the patient was given prophylactic antibiotics. There was hair removed from the operative site using clippers. The patient was brought to the operating room and placed on table in the supine position. Successful general anesthesia was established. We sterilely prepped and draped in the standard fashion. We did not use a tourniquet for this case. We did an exam under anesthesia which showed with his knee flexed at 30 degrees he translated easily 3+ quadrants with no endpoint. We could not evert his patella to neutral.
We did a timeout procedure with the nursing and anesthesia staff confirming the patient, the procedure, and the site.
We marked the two proposed portal sites and injected with half percent Marcaine with epinephrine. We started with a lateral portal 1 cm longitudinally with an 11 blade scalpel and placed the blunt trocar and the camera through this. Under direct needle localization we made our medial portal also 1 cm longitudinally.
The chondral surface on the undersurface of patella showed no changes.
The trochlear groove cartilage showed no changes.
The medial femoral condyle articular surface had no changes.
Medial tibial plateau articular surface had no changes.
Medial meniscus was intact.
ACL was intact.
The lateral femoral condyle articular surface had no changes.
The lateral tibial plateau articular surface had no changes.
Lateral meniscus was intact.
Popliteus was intact
There was evidence intra-articularly of the medial retinacular tear off of the medial aspect of the patella as there was raw tissue and there was there was also a significant amount of lateral translation and tilt. Retraction on the order of approximately a centimeter. There was significant lateral translation with the medial aspect of the patella in line with the center of the trochlear groove and a significant amount of lateral tilt with gapping on the medial side and tightness on the lateral side.
There was a medial plica that was large enough that it was on the medial femoral condyle and we therefore did release this and remove this to the capsule. Electrocautery for hemostasis. We then switched to a medial viewing portal and a lateral working portal did start at the superior pole of the patella with our hook electrocautery device. We did do a lateral retinacular release to subcutaneous tissue all the way to the lateral portal. We then dropped the arthroscopic pump pressure as low as 65 while his systolic blood pressure was between 100 and 117 and did achieve meticulous hemostasis. Once satisfied with this we terminated the arthroscopic portion of the case. We again examined under anesthesia and we can now evert his patella to almost 90 degrees.
The medial incision we did make an approximately inch and a half incision on the medial to superior medial aspect of the patella which we preinjected some half percent Marcaine with epinephrine. I used a 15 blade scalpel to make full-thickness flaps to the skin and used a Bovie for hemostasis. I used Metzenbaum and tenotomy scissors to get down to the medial aspect of the patella and the medial retinaculum. There was minimal tissue remaining and we easily created our medial arthrotomy through his torn retinaculum. We did prepare the medial and superior medial aspect of patella with a rongeur and a curette to bleeding bone. We then placed on this left knee at his 9:00 and 10:30 position double loaded Lupine anchors. We then using a grasping suture medial and superior medialized our tissue plicating this to not only shorten but also thicken this tissue as a part of the repair. Once satisfied with this repair we used remaining Orthocord sutures to repair superficial retinacular tissue over the medial retinacular repair site. We then examined under anesthesia and found his lateral translation at 30 degrees of flexion while under complete anesthesia was less than 1 quadrant with a firm endpoint. We also brought him through full range of motion and found his patella was tracking normally.
We irrigated with sterile normal saline using a bulb syringe. Bovie for hemostasis. We closed his deeper tissue on the open incision with 3-0 Vicryl Mastisol and Steri-Strips for the skin. We closed the portals with 3-0 Monocryl, Mastisol, and Steri-Strips. We injected the knee with a combination of morphine, quarter percent Marcaine without epinephrine, diluted with normal saline. We placed a sterile compressive dressing, awoke the patient from anesthesia, and transferred in stable condition to the stretcher and the recovery room. Sharp, sponge, and instrument count were correct at the termination case and there were no complications.
Diagnosis: Left Patellar dislocation
Procedures: Left knee arthroscopy with lateral retinacular release and open medial retinacular repair
Procedure:
patient is a 19-year-old male who had originally dislocated his patella in the eighth grade. He had a subsequent patellar dislocation recently 9/13/2025 when he fell over a cooler. Review his MRI showed that he had a patellar dislocation with injury to his medial retinaculum off of the medial aspect of the patella. We did discuss nonoperative versus operative treatments but did elect for surgical intervention. We discussed risk and benefit surgery including potential complications and time frames for recovery which he understood and agreed.
We marked the operative site in the preoperative holding area and the patient was given prophylactic antibiotics. There was hair removed from the operative site using clippers. The patient was brought to the operating room and placed on table in the supine position. Successful general anesthesia was established. We sterilely prepped and draped in the standard fashion. We did not use a tourniquet for this case. We did an exam under anesthesia which showed with his knee flexed at 30 degrees he translated easily 3+ quadrants with no endpoint. We could not evert his patella to neutral.
We did a timeout procedure with the nursing and anesthesia staff confirming the patient, the procedure, and the site.
We marked the two proposed portal sites and injected with half percent Marcaine with epinephrine. We started with a lateral portal 1 cm longitudinally with an 11 blade scalpel and placed the blunt trocar and the camera through this. Under direct needle localization we made our medial portal also 1 cm longitudinally.
The chondral surface on the undersurface of patella showed no changes.
The trochlear groove cartilage showed no changes.
The medial femoral condyle articular surface had no changes.
Medial tibial plateau articular surface had no changes.
Medial meniscus was intact.
ACL was intact.
The lateral femoral condyle articular surface had no changes.
The lateral tibial plateau articular surface had no changes.
Lateral meniscus was intact.
Popliteus was intact
There was evidence intra-articularly of the medial retinacular tear off of the medial aspect of the patella as there was raw tissue and there was there was also a significant amount of lateral translation and tilt. Retraction on the order of approximately a centimeter. There was significant lateral translation with the medial aspect of the patella in line with the center of the trochlear groove and a significant amount of lateral tilt with gapping on the medial side and tightness on the lateral side.
There was a medial plica that was large enough that it was on the medial femoral condyle and we therefore did release this and remove this to the capsule. Electrocautery for hemostasis. We then switched to a medial viewing portal and a lateral working portal did start at the superior pole of the patella with our hook electrocautery device. We did do a lateral retinacular release to subcutaneous tissue all the way to the lateral portal. We then dropped the arthroscopic pump pressure as low as 65 while his systolic blood pressure was between 100 and 117 and did achieve meticulous hemostasis. Once satisfied with this we terminated the arthroscopic portion of the case. We again examined under anesthesia and we can now evert his patella to almost 90 degrees.
The medial incision we did make an approximately inch and a half incision on the medial to superior medial aspect of the patella which we preinjected some half percent Marcaine with epinephrine. I used a 15 blade scalpel to make full-thickness flaps to the skin and used a Bovie for hemostasis. I used Metzenbaum and tenotomy scissors to get down to the medial aspect of the patella and the medial retinaculum. There was minimal tissue remaining and we easily created our medial arthrotomy through his torn retinaculum. We did prepare the medial and superior medial aspect of patella with a rongeur and a curette to bleeding bone. We then placed on this left knee at his 9:00 and 10:30 position double loaded Lupine anchors. We then using a grasping suture medial and superior medialized our tissue plicating this to not only shorten but also thicken this tissue as a part of the repair. Once satisfied with this repair we used remaining Orthocord sutures to repair superficial retinacular tissue over the medial retinacular repair site. We then examined under anesthesia and found his lateral translation at 30 degrees of flexion while under complete anesthesia was less than 1 quadrant with a firm endpoint. We also brought him through full range of motion and found his patella was tracking normally.
We irrigated with sterile normal saline using a bulb syringe. Bovie for hemostasis. We closed his deeper tissue on the open incision with 3-0 Vicryl Mastisol and Steri-Strips for the skin. We closed the portals with 3-0 Monocryl, Mastisol, and Steri-Strips. We injected the knee with a combination of morphine, quarter percent Marcaine without epinephrine, diluted with normal saline. We placed a sterile compressive dressing, awoke the patient from anesthesia, and transferred in stable condition to the stretcher and the recovery room. Sharp, sponge, and instrument count were correct at the termination case and there were no complications.
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