Requesting assistance regarding this case. Multiple coders review and came to a road block because the provider code selections are not the same, we need additional assistance. Please!!!!
PREOPERATIVE DIAGNOSES: Left knee:
1. Medial meniscus tear.
2. Mild osteoarthritis.
3. ACL sprain.
4. Posterior ganglion cyst.
5. Chronic Osgood-Schlatter disease.
POSTOPERATIVE DIAGNOSES: Left knee:
1. Medial meniscus tear.
2. Mild osteoarthritis.
3. ACL sprain.
4. Posterior ganglion cyst.
5. Chronic Osgood-Schlatter disease.
PROCEDURES PERFORMED: Left knee:
1. Examination under anesthesia.
2. Diagnostic arthroscopy.
3. Arthroscopic partial medial meniscectomy.
4. Arthroscopic excision of posterior ganglion cyst.
5. Arthroscopic chondroplasty of patellofemoral joint medial femoral
condyle.
6. Open excision of Osgood-Schlatter ossicle with tibial tubercle plasty
and debridement/repair of patellar tendon
ANESTHESIA: General, supplemental regional nerve block.
ESTIMATED BLOOD LOSS: Minimal.
INTRAOPERATIVE COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: Regional nerve block was performed in the
preoperative holding area. The patient was brought to the operating room
and placed under general anesthesia. The left knee was then closely
examined. The patient Lachman's was stable. If there was any difference between
the 2 sides, it was pretty subtle, and he did have a negative pivot shift
and the knee was otherwise stable with full motion, just being limited by
soft tissues in flexion. The left lower extremity was then prepped and
draped in routine sterile fashion. The limb was exsanguinated and
tourniquet inflated to 300 mmHg. We performed diagnostic arthroscopy.
Standard anterolateral and anteromedial arthroscopies were created. The
arthroscope was introduced in the knee joint. Superior pouch was normal.
The patellofemoral joint had some mild degenerative changes with some loose
fragments of cartilage, mostly grade 2, some small areas of grade 3. These
were debrided back to stable margin, but no full-thickness areas were
present. Medial and lateral gutters were normal. The medial compartment
was then entered, and there was a tear of the junction of the mid body and
posterior horn of the medial meniscus. It was resected back to stable
margin using arthroscopic basket and shaver. Medial articular surfaces of
the medial femoral condyle had some mild chondromalacia, which was
debrided. The patient did have a cyst on his preoperative MRI scan that was just
posterior to the PCL attachment. I did just open the capsule in that area,
being very careful around the vessels, and was able to drain the cyst and
debride it somewhat in that area. Intercondylar notch showed his ACL was
intact and that he just had had a sprain to it, but did not disrupt any
significant fibers to it. The lateral compartment was then entered.
Lateral meniscus and lateral articular surfaces were still in good
condition. The arthroscope and instruments were then removed. We then
made a longitudinal incision centered over the tibial tubercle area.
Dissection was carried down through skin and subcutaneous tissue,
identifying the tibial tubercle and patellar tendon. We sharply incised
the patellar tendon longitudinally and shelled out Osgood-Schlatter's
ossicle that was present just proximal to the tubercle, debrided some of
the tendon in that area, and then the actual tibial tubercle had some
spurring of it and we debrided that down to nice smooth tubercle, debrided
some of the tendon in that area. We did not completely detach the tendon,
but we did repair it back down to the tibial tubercle using a double-loaded
suture anchor to nicely reapproximate the tendon back down to the smoothed
off tubercle. The wound was then irrigated. We did use mini C-arm to confirm we had a nice smooth tubercle, and that the ossicle had been
removed. Wounds were then closed. Sterile dressing was applied.
Tourniquet was deflated. He tolerated the procedure well and was
transferred to recovery room in stable condition. There were no apparent
intraoperative complications.
PREOPERATIVE DIAGNOSES: Left knee:
1. Medial meniscus tear.
2. Mild osteoarthritis.
3. ACL sprain.
4. Posterior ganglion cyst.
5. Chronic Osgood-Schlatter disease.
POSTOPERATIVE DIAGNOSES: Left knee:
1. Medial meniscus tear.
2. Mild osteoarthritis.
3. ACL sprain.
4. Posterior ganglion cyst.
5. Chronic Osgood-Schlatter disease.
PROCEDURES PERFORMED: Left knee:
1. Examination under anesthesia.
2. Diagnostic arthroscopy.
3. Arthroscopic partial medial meniscectomy.
4. Arthroscopic excision of posterior ganglion cyst.
5. Arthroscopic chondroplasty of patellofemoral joint medial femoral
condyle.
6. Open excision of Osgood-Schlatter ossicle with tibial tubercle plasty
and debridement/repair of patellar tendon
ANESTHESIA: General, supplemental regional nerve block.
ESTIMATED BLOOD LOSS: Minimal.
INTRAOPERATIVE COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: Regional nerve block was performed in the
preoperative holding area. The patient was brought to the operating room
and placed under general anesthesia. The left knee was then closely
examined. The patient Lachman's was stable. If there was any difference between
the 2 sides, it was pretty subtle, and he did have a negative pivot shift
and the knee was otherwise stable with full motion, just being limited by
soft tissues in flexion. The left lower extremity was then prepped and
draped in routine sterile fashion. The limb was exsanguinated and
tourniquet inflated to 300 mmHg. We performed diagnostic arthroscopy.
Standard anterolateral and anteromedial arthroscopies were created. The
arthroscope was introduced in the knee joint. Superior pouch was normal.
The patellofemoral joint had some mild degenerative changes with some loose
fragments of cartilage, mostly grade 2, some small areas of grade 3. These
were debrided back to stable margin, but no full-thickness areas were
present. Medial and lateral gutters were normal. The medial compartment
was then entered, and there was a tear of the junction of the mid body and
posterior horn of the medial meniscus. It was resected back to stable
margin using arthroscopic basket and shaver. Medial articular surfaces of
the medial femoral condyle had some mild chondromalacia, which was
debrided. The patient did have a cyst on his preoperative MRI scan that was just
posterior to the PCL attachment. I did just open the capsule in that area,
being very careful around the vessels, and was able to drain the cyst and
debride it somewhat in that area. Intercondylar notch showed his ACL was
intact and that he just had had a sprain to it, but did not disrupt any
significant fibers to it. The lateral compartment was then entered.
Lateral meniscus and lateral articular surfaces were still in good
condition. The arthroscope and instruments were then removed. We then
made a longitudinal incision centered over the tibial tubercle area.
Dissection was carried down through skin and subcutaneous tissue,
identifying the tibial tubercle and patellar tendon. We sharply incised
the patellar tendon longitudinally and shelled out Osgood-Schlatter's
ossicle that was present just proximal to the tubercle, debrided some of
the tendon in that area, and then the actual tibial tubercle had some
spurring of it and we debrided that down to nice smooth tubercle, debrided
some of the tendon in that area. We did not completely detach the tendon,
but we did repair it back down to the tibial tubercle using a double-loaded
suture anchor to nicely reapproximate the tendon back down to the smoothed
off tubercle. The wound was then irrigated. We did use mini C-arm to confirm we had a nice smooth tubercle, and that the ossicle had been
removed. Wounds were then closed. Sterile dressing was applied.
Tourniquet was deflated. He tolerated the procedure well and was
transferred to recovery room in stable condition. There were no apparent
intraoperative complications.