KPriceAZ08
Networker
Greetings -
I have a situation where the surgeon was about to perform an arthroscopic meniscectomy and a complication arose at the start of the procedure:
DESCRIPTION OF PROCEDURE: The patient received a preoperative block in the preoperative suite for postoperative pain control. He was then taken to the operating room where he was placed supine on the operating table. Once an adequate LMA was achieved, the patient's right knee was prepped and draped in standard sterile surgical fashion for an arthroscopy. A standard inferolateral portal was established with a 11blade scalpel. When the portal was made, the knife blade immediately snapped secondary to a defect in the middle of the blade (the knife blade did not come off the handle). An inferiomedial portal was then made with a separate new knife blade handle
The arthroscope was then placed into an inferomedial portal and diagnostic arthroscopy was then performed. The knife blade handle was seen briefly through the inferomedial portal and medial aspect of the knee in the medial compartment. However, before it could be grasped with a hemostat, it disappeared in the posteromedial aspect of the knee. The arthroscopy was then halted and a posteromedial incision was made along Langer’s lines in the posteromedial aspect of the knee with the knee flexed at 90 degrees. The incision was approximately 4 cm in length. This was made with a 15-blade scalpel through skin only. Careful dissection down to the posteromedial capsule was then performed with Metzenbaum scissors and pickups. Self retainers were then placed. Great care was taken to minimize risk of injuring the neurovascular bundle by staying directly on the bone in the posteromedial femoral condyle and posterior tibial plateau with the instruments. Using C-arm for localization, a hemostat was used very carefully under direct vision to withdraw the blade from the posteromedial aspect of the joint. C-arm was then used to ensure there was no further evidence of the metal. Once this was verified, C-arm was removed. The posteromedial incision was then closed by reapproximating the posteromedial capsule and posterior subcutaneous incision with 2-0 Vicryl. The skin was reapproximated with a running subcuticular stitch of 3-0 prolene.
The patient’s arthroscopy was then performed ...
Does anyone have knowledge of whether there is opportunity for additional reimbursement in this case? The surgeon spent additional time/work to retrieve the instrument through an additional incision. Perhaps a 22 modifier?
Any coding resource links are greatly appreciated.
Thank you -
K. Price
Columbus, OH
I have a situation where the surgeon was about to perform an arthroscopic meniscectomy and a complication arose at the start of the procedure:
DESCRIPTION OF PROCEDURE: The patient received a preoperative block in the preoperative suite for postoperative pain control. He was then taken to the operating room where he was placed supine on the operating table. Once an adequate LMA was achieved, the patient's right knee was prepped and draped in standard sterile surgical fashion for an arthroscopy. A standard inferolateral portal was established with a 11blade scalpel. When the portal was made, the knife blade immediately snapped secondary to a defect in the middle of the blade (the knife blade did not come off the handle). An inferiomedial portal was then made with a separate new knife blade handle
The arthroscope was then placed into an inferomedial portal and diagnostic arthroscopy was then performed. The knife blade handle was seen briefly through the inferomedial portal and medial aspect of the knee in the medial compartment. However, before it could be grasped with a hemostat, it disappeared in the posteromedial aspect of the knee. The arthroscopy was then halted and a posteromedial incision was made along Langer’s lines in the posteromedial aspect of the knee with the knee flexed at 90 degrees. The incision was approximately 4 cm in length. This was made with a 15-blade scalpel through skin only. Careful dissection down to the posteromedial capsule was then performed with Metzenbaum scissors and pickups. Self retainers were then placed. Great care was taken to minimize risk of injuring the neurovascular bundle by staying directly on the bone in the posteromedial femoral condyle and posterior tibial plateau with the instruments. Using C-arm for localization, a hemostat was used very carefully under direct vision to withdraw the blade from the posteromedial aspect of the joint. C-arm was then used to ensure there was no further evidence of the metal. Once this was verified, C-arm was removed. The posteromedial incision was then closed by reapproximating the posteromedial capsule and posterior subcutaneous incision with 2-0 Vicryl. The skin was reapproximated with a running subcuticular stitch of 3-0 prolene.
The patient’s arthroscopy was then performed ...
Does anyone have knowledge of whether there is opportunity for additional reimbursement in this case? The surgeon spent additional time/work to retrieve the instrument through an additional incision. Perhaps a 22 modifier?
Any coding resource links are greatly appreciated.
Thank you -
K. Price
Columbus, OH
