Billing and operative report,
29877-$2200, 29874-mod 59-$2300, 29875-mod 59-$2700, 29999-anterior cruciate ligament debridement-$3000-Preoperative Diagnosis-Left knee ganglion cyst, patellar chondromalacia, Postoperative Diagnoses: Left knee cyst , grade 1 patellar chondromalacia, grade 2 lateral tibial plateau chondromalacia, patrial anterior cruciate ligament tear, loose body, major synovitis Procedure in DetailLeft kneed arthoscopy, major synovectomy, patellar chondroplasty, Modifier 59, loose body removal, debridement of anterior cruciate ligament, ganglion cyst removal.
Procedure in Detail The patient was identified in the preoperative holding area on August 5, 2008. The left knee was marked as the correct site for surgery. Prophylactic antibiotics were given. The patient was taken back to the operating room where an LMA was done. Her left leg was positioned, prepped and draped in the usual sterile fashion for surgery. A thigh tourniquet was elevated at 300 mmHg. A 15-blade was used to make standard anterolateral and anteromedial arthroscopy portals and the arthroscope was introduced through the anterolateral portal. Findings in the Patellofemoral Compartment:The patella was noted to have some mild chondromalacia, grade1, in the medial and lateral articular facets. The shaver was used to perform a thorough atraumatic chondroplasty, Modifier 59. This was done in an atraumatic fashion. Medial CompartmentThe medial gutter did not have any loose bodies. The anterior aspect of the medial compartment had extensive synovitis. A thorough atruamatic synovectomy was performed. Th medial meniscus was visualized and probed and noted to be intact. Teh medial femoral condyle and medial tibial plateau had no chondral changes. Intraarticular Notch:The anterior aspect of the notch had extensive synovitis. Asynovectomy was performed at the base of the tibial attachment of the ACL. A large cystic structure was noted. this was probed and noted to be fluctuant in nature. The shaver was then used to perform a ganglion cyst removal. this was done atraumatically. However, at the base of the cyst-like structure, ACL fibers were notes to be partially torn. A shaver wa then used to perform a debridement of the ACL there. this was done atraumatically so as to not destabilize or damage the remaining spect of the ACL which was then probed and noted to be solid and intact. Lateral Compartment:The anterior aspect of the lateral copartment had extensive synovitis. A synovectomy was performed atraumatically. Multiple loose bodies were noted int he later compartment. These wer subsequently removed. The lateral meniscus was visualized and probed and noted to be intact. The lateral tibial plateau had grade 2 chondral changes. A chondroplasty was performed. the lateral remoral condyle had no chondral changes. The lateral gutter had no loose bodies
Satisfied with the arthroscopy, the arthroscopy and shaver were removed. The joint was lavaged. Then portals were closed with 3-0 nylon suture, Sterile dressings consisting of Xeroform, 4x4s, ABD, Webril and an Ace wrap were placed. The tourniquet was let down. The patient was awakened and taken to the PACU in stable condition. There were no complications during this procedure. I was present for and performed the entire procedure myself.