RSKIPPER2
New
- Messages
- 2
- Location
- Old town, ID
I need help! Everything I have reviewed and the below OP report I found 27599 is the best fit. I have been asked to review 27514 but since there is no documentation of a fracture this does not fit. Based on this "replaced and reduced the fragment into the bed and was able to turn it and key it in perfectly. I pinned it with a small K-wire in this position" they feel it does fit 27514. Tell me how you would code this?
This patient was met in the operating room, where general anesthesia was induced. The right lower extremity was prepped and draped in usual sterile fashion. It was elevated and exsanguinated with an Esmarch and tourniquet inflated to 250 mmHg. Preoperatively, she received two grams of Ancef IV. An extensile anteromedial incision was made and a midvastus approach was utilized to expose her joint with an arthrotomy. I gently subluxated the patella laterally and was able to directly visualize the defect for the medial femoral condyle. Again, this was a full thickness chondral defect. The base was actually red and raw appearing. It appeared to have contained exposed cancellous bone. The loose body was identified and one solid fragment. It was in the suprapatellar pouch. I was able to extract this using a small forceps damaging it. It was placed on the back table. A curette was then used to remove any blood clot, debris and freshen the bone and base of the lesion. I then replaced and reduced the fragment into the bed and was able to turn it and key it in perfectly. I pinned it with a small K-wire in this position.
The K-wire was centrally located and I used this to overream and place a Stryker Headless 2.5 mm x 14 mm screw with separate pitches that would compress the fragment in the central location. I made sure to countersunk this headless screw below the level of the articular cartilage. I placed this in a relatively secured position and then four Arthrex chondral darts were used in a box pattern around this as peripherally as I could make them to secure the fragment rotationally and compress its edges. These all went in nicely. Once this was completed, I took a final photograph of the reduced fragment and fixation equipment in place. The knee was irrigated. A local anesthetic comprised of 150 mL of normal saline, 30 mg of Toradol, 30 mL of 0.5% ropivacaine was injected around the joint and the arthrotomy. This was repaired with a #2 Quill sutures. Interrupted 2-0 Vicryl and running 3-0 Monocryl sutures were used to close the skin. A Steri-Strips and a sterile compressive wrap was applied. This pleasant patient was placed in a hinged knee brace with range of motion 0 to 60. She will be touch down weightbearing for the first two weeks. We also recommend use of a CPM machine for home use.
This patient was met in the operating room, where general anesthesia was induced. The right lower extremity was prepped and draped in usual sterile fashion. It was elevated and exsanguinated with an Esmarch and tourniquet inflated to 250 mmHg. Preoperatively, she received two grams of Ancef IV. An extensile anteromedial incision was made and a midvastus approach was utilized to expose her joint with an arthrotomy. I gently subluxated the patella laterally and was able to directly visualize the defect for the medial femoral condyle. Again, this was a full thickness chondral defect. The base was actually red and raw appearing. It appeared to have contained exposed cancellous bone. The loose body was identified and one solid fragment. It was in the suprapatellar pouch. I was able to extract this using a small forceps damaging it. It was placed on the back table. A curette was then used to remove any blood clot, debris and freshen the bone and base of the lesion. I then replaced and reduced the fragment into the bed and was able to turn it and key it in perfectly. I pinned it with a small K-wire in this position.
The K-wire was centrally located and I used this to overream and place a Stryker Headless 2.5 mm x 14 mm screw with separate pitches that would compress the fragment in the central location. I made sure to countersunk this headless screw below the level of the articular cartilage. I placed this in a relatively secured position and then four Arthrex chondral darts were used in a box pattern around this as peripherally as I could make them to secure the fragment rotationally and compress its edges. These all went in nicely. Once this was completed, I took a final photograph of the reduced fragment and fixation equipment in place. The knee was irrigated. A local anesthetic comprised of 150 mL of normal saline, 30 mg of Toradol, 30 mL of 0.5% ropivacaine was injected around the joint and the arthrotomy. This was repaired with a #2 Quill sutures. Interrupted 2-0 Vicryl and running 3-0 Monocryl sutures were used to close the skin. A Steri-Strips and a sterile compressive wrap was applied. This pleasant patient was placed in a hinged knee brace with range of motion 0 to 60. She will be touch down weightbearing for the first two weeks. We also recommend use of a CPM machine for home use.