BFAITHFUL
Expert
medial component was entered and the medial meniscus was inspected along its entirety and superior and inferior articular surfaces were found to be intact w/out any areas or tear detachement. There was noted to be a large osteochondral lesion consisting entirely cartilage with no adherent osseous material along its posterior aspect. This was noted to be essentially detached with only some small synovial hinges attaching it to the intercondylar region. Some of this was noted to be adherenet to thte anterior cruciate ligament. There was noted to be in addition, a smaller chondral fragment posteior to this, which was surrounded by synovial tissue. The large chondral fragment was evaluated for possible repair, however due to lack of any bony material to replace back into the defect this would not heal and this was excised sharply, morcellized and removed through the medial patellar arhtroscopic portal superior. The second loose osteochondral fragment was also removed in a similar fashioni. No further loose fragments were found. Lateral meniscus inspected articular surfaces found to be intact
Attention was then redirected back to the medial femoral condyle. The defect was further evaluated and felt to be in the nonarticular portion of the medial femoral condyle with only one edge being in the juxtarticular area. It was felt to optimize the patient's chance at recovery that osteochondral microfracture would be performed in this area of defect to promote fibrocartilage formation. The osteochondral picks were then introduced into the medial femoral condyle and the area which had been debrided with the shaver where the defect had previously been, did undergo a microfracture technique using the osteochondral picks. this was further debrided with the shaver to remove any loose chondral fragments and the knee was irrigated.
dr wants to do 29887, (definitely not!) b/cuz he didn't do the repair but just excised the two osteochondral lesions, but also performed microfracture .
im thinking just 29879. or 29879 & 29874 (but this may be bundled)
what you guys think?
Attention was then redirected back to the medial femoral condyle. The defect was further evaluated and felt to be in the nonarticular portion of the medial femoral condyle with only one edge being in the juxtarticular area. It was felt to optimize the patient's chance at recovery that osteochondral microfracture would be performed in this area of defect to promote fibrocartilage formation. The osteochondral picks were then introduced into the medial femoral condyle and the area which had been debrided with the shaver where the defect had previously been, did undergo a microfracture technique using the osteochondral picks. this was further debrided with the shaver to remove any loose chondral fragments and the knee was irrigated.
dr wants to do 29887, (definitely not!) b/cuz he didn't do the repair but just excised the two osteochondral lesions, but also performed microfracture .
im thinking just 29879. or 29879 & 29874 (but this may be bundled)
what you guys think?