Debridement Proximal Medial Patella Tendon

dyoungberg

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I am stumped on this one. Anyone have an idea on how to code this procedure? I'm thinking maybe 27332.

PREOP DIAGNOSIS: RIGHT KNEE CHRONIC PATELLA TENDINOPATHY WITH LONGITUDINAL TEAR ANTERIOR PROXIMAL MEDIAL PATELLA TENDON

POSTOP DIAGNOSIS: SAME

PROCEDURE: DEBRIDEMENT OF DEGENERATIVE PORTION OF PROXIMAL MEDIAL PATELLA TENDON

ANESTHESIA: GENERAL ET

INTRODUCTION: Routine preop evaluation revealed no medical contraindication to surgery. The patient and family were consulted at length regarding the relative risks, benefits, and alternatives to the above elected procedure. They understood these risks to include but not be limited to infection, sepsis, osteomyelitis, DVT, PE, stroke, MI, death, nerve or blood vessel damage, RSD, persistent pain, persistent stiffness, loss of motion, wound dehiscence, synovial fistula, among others. Understanding all the above risks and that no guarantees were made nor implied, the patient freely consented to proceed.

PROCEDURE: Ms. Wilson was taken to the operating room on 3/9/12 where she was transferred to the OR table and placed in the supine position without event. Prior to initiation of the operative procedure, the American Academy of Orthopedic Surgeons’ timeout protocol was instituted. This assured the patient’s name, the correct extremity, the correct side, the patient’s allergies, their preoperative medications and antibiotics. Following completion of the appropriate timeout and verification of all the above, we proceeded with the operative procedure. She was induced under general anesthesia and intubated via the ET route. The patient was given 1 gram Ancef as antibiotic preop prophylaxis in preoperative holding. A tourniquet was placed about the right proximal thigh. All bony prominences were carefully and thoroughly padded. The head and neck were secured in neutral position. The RLE was then prepped and draped in usual sterile fashion. The limb was exsanguinated with a sterile Esmarch bandage. The tourniquet was inflated to 250 mm’s mercury.

A 3.0 cm skin incision was made at the inferomedial patella through the previous scar. Sharp dissection was carried down to the pretendinous fascia. A longitudinal incision was made in the paratenon exposing the proximal anterior medial portion of the patella tendon. The area of degenerative tendon was grossly evident and was adjacent to a large 2.0 Ethibond suture. The suture was removed. The grossly degenerative component of the tendon was excised removing approximately 25% of the proximal surface area of the patella tendon.
The wound was then copiously irrigated with normal saline and closed in layers with 3-0
Monocryl subcuticular sutures, followed by 3-0 nylon vertical mattress sutures. A bulky compressive knee dressing was applied. The patient was extubated in the OR and returned to recovery in good condition. There were no noted complications. Sponge, needle, instrument counts were correct at the end of the operative procedure. EBL was minimal.
Tourniquet time was 15 minutes.



Thanks for any help with this one. Happy Monday everyone!
 
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