Arthroscopic removal of patella componet

littlelora

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Ok so, I have never EVER in 11 years had this performed as a procedure! Im super confused about this one! Im leaning toward removal of foreign/loose body 29874, but I don't think that is correct. And it seems like there was way more work done that that, they had an arthro lavage as well for a septic knee joint. Any help is appreciated!
 

AlanPechacek

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Your query lacks sufficient detail or content to be very helpful, such as the Operative Report containing the Preoperative evaluation of the patient and indications for surgery, the Postoperative Diagnosis, and the Description of the Procedure. Your note indicates that the patient had an infected arthroplasty for which the Arthroscopic Surgical lavage was done to "wash out" the joint, 29871 (the primary procedure). From there comes the issue of the patellar component. Was it entirely loose and free in the joint, acting as a Loose Body (or as a surgically implanted Foreign Body if you prefer)? If so, then the coding could be supplemented by 29874 with the appropriate Modifier(s) 22 or 51 or both. If the Patellar component was just loose on the patella, but not fully free from it, then there would have been some extra work involved in freeing it from the patella for removal from the joint. The indications for doing this would need to be in the Operative Report somewhere as this applies to Clinical Judgement (Medical Necessity) for removing it. I would still use 29874 for this as well with Modifiers as above. I don't think that a "modified" 27488: Removal of Prosthesis ..., as described in CPT, would be the best or correct for removal of the Patellar Component alone. Your Diagnosis codes would have to include the Infection of a joint prosthesis (T84.5 _X _, with 5th Character 3 for right, 4 for left knee, and 7th Character A since this is the Initial Treatment for the joint infection), and T84.03 _ _ (6th Character 2 for right knee, 3 for left knee, and A for 7th Character) for the Mechanical Loosening of the Patellar Component. As always for something this unusual, send the Operative Report with the claim.

Hopefully this will be of some help.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 

littlelora

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Body of the procedure: A lateral supra patella portal was created and the arthroscope was introduced into the knee. Knee was insufflated with normal sterile saline solution. A second medial suprapatellar incision was created and the arthroscopic shaver was introduced. This was used to copiously irrigate the knee to allow for more complete visualization followed by utilizing the shaver to debride the anti-inflammatory and hypertrophic tissues within the knee. There did not appear to be any difficulty with the femoral component. Upon isolating and debriding the soft tissues around the patella component was noted to be frank looseness of the inferior piece. The inferolateral peg was broken and the component was able to rotate about the medial peg. The more superior fragment was loose as well though not as frankly loose as the inferior piece. The attention was turned to continuing the debridement of the knee which was performed in a tricompartmental management of the low attempt was made to enter the posterior aspect of the knee. Once the knee had been thoroughly cleaned and debrided and irrigation revealed a little further turbid fluid attention was paid to removal of the patella components. A slightly superior lateral portal was created and probe was introduced and ulilized to elevate the patella component off the patella. A grasper was used to draw the patella component up to the superiomedial portal which was opened and the fragment of patella component was removed. Similar process was then performed on the superior fragment. Further debridement of the patella was performed. No real attempt was made to remove all the cement from the patella component.

Sorry It took so long to respond, I've been having trouble logging on the last few days!

pre-op DX-septic left total knee arthroplasty
post-op DX- septic left total knee arthroplasty, fracture patella component left knee
 
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