Hi list,
I am still fairly new to Ortho and not an expert yet lol
So I know to code 29880-RT
BUT would you also code 27340-rt and 29876??
Needing some guidance here , please
Thanks in advance,
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSES:
Right knee contusion sprain with recurrent prepatellar
bursitis and possible meniscal tear of the right knee.
POSTOPERATIVE DIAGNOSES:
Recurrent prepatellar bursitis, hemorrhagic of the right knee
with posterior horn tear of the medial meniscus, midportion
tear of the lateral meniscus and synovitis with disruption of
the ligament of mucosum.
PROCEDURE:
Arthroscopic examination with synovectomy and partial medial
and lateral meniscectomies with open excision of prepatellar
bursa of the right knee. The bursa measured about 12 x 10 cm.
The bursa was noted to be full of clotted blood also.
SPECIMENS:
Sent for pathology.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
TOURNIQUET TIME:
About 30 minutes.
BRIEF CLINICAL HISTORY:
This is a 74-year-old white female with history of falls. She
fell and injured her right knee. She had recurrent swelling
of the bursa and actually had it aspirated several times, but
the swelling would return. She also had MRI scan, which
showed a possible meniscal tear. The options of conservative
care versus surgery were discussed with her at length. She
requested surgical treatment. Because of meniscal tear, we
Are going to proceed with arthroscopic examination also along with
excision of the bursa.
DESCRIPTION OF PROCEDURE:
After obtaining informed consent, the patient was brought to the
operating room and placed on the table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed on right
proximal thigh. Next, a time-out was performed.
The patient identified, appropriate body site had been
marked and she received appropriate antibiotics. Next, the
skin was prepped to 0.5% lidocaine with epinephrine was placed
in the knee joint. The right leg was then sterilely prepped
and draped in a routine manner. An anterolateral arthroscopy
portal was then made and arthroscopic examination of the joint
was performed. Examination shows mild inflammation in the
suprapatellar area. The patellofemoral joint was normal in
appearance. The medial gutter showed mild inflammation of the
synovium. The medial joint was examined, and there was noted
to be small tear of the posterior horn of the medial meniscus,
but the articular surfaces were normal in appearance. There
was mild inflammation of the synovium noted here also. The
Ligamentum mucosum was noted to be disrupted and impinging in
the joint. The ACL and PCL were intact. An anteromedial
portal was made and medial meniscus was probed and again the
tear was noted. Next, with the aid of a punch and the shaver,
the meniscus was debrided back to stable edges. Remaining
portions were probed and noted to be stable. Next the lateral
compartment was examined and the lateral meniscus was probed.
There was noted to be a tear on the inside and mid portion,
radial and this was debrided with a punch and shaver back to
stable edges. The articular surfaces were normal in
appearance. Next, the ligament of mucosum was debrided along
with the inflamed synovium in medial and lateral joints. The
medial gutter and suprapatellar area also were debrided. The
lateral gutter was normal in appearance. Next, the
arthroscopy equipment was removed from the knee joint.
Remainder of the knee exam was otherwise unremarkable. Next,
a longitudinal incision was then made over the area of the
prepatellar bursa. This was carefully divided from the
surrounding tissue with the aid of electrocautery. A portion
of the skin was excised also to help with closure later. The
bursa was opened slightly while being removed and noted to be
full of clotted blood and very hemorrhagic. The bursa
measures about 12 x 10 cm. This was removed and noted be
adequately excised. The tourniquet was inflated to start of
procedure and this was deflated at the conclusion. Tourniquet
time was about 30 minutes. Adequate hemostasis was obtained
With eltrocautery. The wound was then copiously irrigated. It was
elected not to leave in a drain. Next, interrupted Vicryl
sutures used to approximate the deep tissue and nylon sutures
were used to approximate the skin edges. The medial portal
was closed with nylon and it was elected to leave the lateral portal opened and
it was noted to be stable. Next, Xeroform was placed on the
incisions after infiltrating the tissue with 1% lidocaine and
0.25% Marcaine. A sterile dressing was then applied. She was
placed in a brace to keep her leg straight and is to follow
up on Monday for dressing changes. She tolerated the
procedure well without difficulty and was transferred to the
recovery in stable condition.
I am still fairly new to Ortho and not an expert yet lol
So I know to code 29880-RT
BUT would you also code 27340-rt and 29876??
Needing some guidance here , please
Thanks in advance,
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSES:
Right knee contusion sprain with recurrent prepatellar
bursitis and possible meniscal tear of the right knee.
POSTOPERATIVE DIAGNOSES:
Recurrent prepatellar bursitis, hemorrhagic of the right knee
with posterior horn tear of the medial meniscus, midportion
tear of the lateral meniscus and synovitis with disruption of
the ligament of mucosum.
PROCEDURE:
Arthroscopic examination with synovectomy and partial medial
and lateral meniscectomies with open excision of prepatellar
bursa of the right knee. The bursa measured about 12 x 10 cm.
The bursa was noted to be full of clotted blood also.
SPECIMENS:
Sent for pathology.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
TOURNIQUET TIME:
About 30 minutes.
BRIEF CLINICAL HISTORY:
This is a 74-year-old white female with history of falls. She
fell and injured her right knee. She had recurrent swelling
of the bursa and actually had it aspirated several times, but
the swelling would return. She also had MRI scan, which
showed a possible meniscal tear. The options of conservative
care versus surgery were discussed with her at length. She
requested surgical treatment. Because of meniscal tear, we
Are going to proceed with arthroscopic examination also along with
excision of the bursa.
DESCRIPTION OF PROCEDURE:
After obtaining informed consent, the patient was brought to the
operating room and placed on the table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed on right
proximal thigh. Next, a time-out was performed.
The patient identified, appropriate body site had been
marked and she received appropriate antibiotics. Next, the
skin was prepped to 0.5% lidocaine with epinephrine was placed
in the knee joint. The right leg was then sterilely prepped
and draped in a routine manner. An anterolateral arthroscopy
portal was then made and arthroscopic examination of the joint
was performed. Examination shows mild inflammation in the
suprapatellar area. The patellofemoral joint was normal in
appearance. The medial gutter showed mild inflammation of the
synovium. The medial joint was examined, and there was noted
to be small tear of the posterior horn of the medial meniscus,
but the articular surfaces were normal in appearance. There
was mild inflammation of the synovium noted here also. The
Ligamentum mucosum was noted to be disrupted and impinging in
the joint. The ACL and PCL were intact. An anteromedial
portal was made and medial meniscus was probed and again the
tear was noted. Next, with the aid of a punch and the shaver,
the meniscus was debrided back to stable edges. Remaining
portions were probed and noted to be stable. Next the lateral
compartment was examined and the lateral meniscus was probed.
There was noted to be a tear on the inside and mid portion,
radial and this was debrided with a punch and shaver back to
stable edges. The articular surfaces were normal in
appearance. Next, the ligament of mucosum was debrided along
with the inflamed synovium in medial and lateral joints. The
medial gutter and suprapatellar area also were debrided. The
lateral gutter was normal in appearance. Next, the
arthroscopy equipment was removed from the knee joint.
Remainder of the knee exam was otherwise unremarkable. Next,
a longitudinal incision was then made over the area of the
prepatellar bursa. This was carefully divided from the
surrounding tissue with the aid of electrocautery. A portion
of the skin was excised also to help with closure later. The
bursa was opened slightly while being removed and noted to be
full of clotted blood and very hemorrhagic. The bursa
measures about 12 x 10 cm. This was removed and noted be
adequately excised. The tourniquet was inflated to start of
procedure and this was deflated at the conclusion. Tourniquet
time was about 30 minutes. Adequate hemostasis was obtained
With eltrocautery. The wound was then copiously irrigated. It was
elected not to leave in a drain. Next, interrupted Vicryl
sutures used to approximate the deep tissue and nylon sutures
were used to approximate the skin edges. The medial portal
was closed with nylon and it was elected to leave the lateral portal opened and
it was noted to be stable. Next, Xeroform was placed on the
incisions after infiltrating the tissue with 1% lidocaine and
0.25% Marcaine. A sterile dressing was then applied. She was
placed in a brace to keep her leg straight and is to follow
up on Monday for dressing changes. She tolerated the
procedure well without difficulty and was transferred to the
recovery in stable condition.