Question Chronic Patellar dislocation

bgbarrett

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Need help coding this OP report. :oops:
29870, 27422, 27350, 27428, 27350, 20680?

A knee scope was inserted through the superolateral patellar portal to evaluate the joint and pictures were obtained showing the diseased lateral patellar facet and lateral femoral condyle. A longitudinal midline knee incision as such would be used for a total knee replacement was utilized. Mobile windows were created. A left lateral retinacular release as well as an extensive release of the vastus lateralis from the IT band and distal femur was performed to help mobilize the lateral structures. We then turned our attention to the tibial tubercle osteotomy. Here, the soft tissues on the lateral aspect of the tibia were elevated. A sagittal saw was used to create the tibial tubercle osteotomy. The tubercle was then greensticked medially. This improved patellar tracking. We then elevated the medial retinaculum and VMO from the medial aspect of the tibia. Care was taken to preserve as much vascularity of the patella as possible including the fat pad and the medial inferior geniculate artery. The VMO was elevated and we then took the semitendinosus graft using a tendon stripper. It was identified and then a tendon stripper was used to harvest the graft. After careful consideration and consultation with Dr. Roger Timperlake, we evaluated the lateral aspect of her knee. He assisted with the graft harvest, and we both agreed that the diseased area of the lateral facet of the patella would be a pain generator. The quadriceps tendon was elevated from off the patella on this side. A sagittal saw was used to remove the lateral patellar facet. We then used the lateral aspect of the vastus. A suture was placed there and then tunneled into the VMO, and this improves patellar tracking as well. The tibial tubercle osteotomy was fixed with cannulated screws. #2 Tycron suture was used to transfer the vastus lateralis as well as for the VMO advancement. Prior to the VMO advancement, the MPFL graft was sutured to the anterior aspect of the patella. It was too short and we felt the patella was too small to perform any patellar drilling, thus risking fracture. The VMO was then closed over. The retinaculum was closed with 0 Vicryl after copious amounts of irrigation was performed. A drain was placed through the superolateral portal. We then performed a layered closure, closing the mobile windows, followed by the subcutaneous tissues and skin. A sterile dressing was applied. The hardware from the right knee was removed through the same approach as insertion. All hardware was removed, c-arm was utilized to localize and confirm. A layered closure was performed and a sterile dressing applied.
 

Orthocoderpgu

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I'm hoping to give you some direction here. This was a totally open procedure, and you have down 29870. No arthroscopic procedure was performed, and this one could not be billed even if it were. ** I would choose 27420 over 27422 since it seems a bony block was moved medially to improve alignment. There is no bony block in 27422. ** 27428 is intra-articular ligaments: ACL & PCL. Neither of these were addressed. I would use 27427 for the MPFL. ** 27350 seems to be an "incidental" procedure and would not be reported. ** I don't see any previously place hardware removal 20680. Even if there were, and it was removed from the same anatomical area, it would be bundled into the procedures and not reported separately. Take all the codes that you have listed and enter them into an Encoder. There are several coding conflicts there. Like I say, I hope this information is helpful.
 
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Orthocoderpgu

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You can't code surgeries without some sort of encoder. The company/clinic you are working for probably feels like it is not worth the expense, but they are already paying for it. Encoders pay for themselves in increased production and accuracy. All of those codes hit edits, and I was able to show that in just a few seconds and know which codes hit edits and why. It would take a coder not seconds, but several minutes to look up the edits without an encoder. I repeat, encoders pay for themselves.
 
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cgaston

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I second Orthocoderpgu!

I coded for General Surgery the "old fashioned way" using my books and a paper copy of the NCCI edits. It can be done without an encoder but your productivity goes way down!
 

Orthocoderpgu

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I would show your clinic manager these messages. They "think" they are not spending money on an encoder, but they are. They pay for themselves and are very useful even in E/M coding. AS an example, pelvis X-rays are bundled into hip X-rays but most coders will not pick up on that without an encoder.
 
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