Failed knee replacement

jdibble

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Daytona Beach, FL
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I am having trouble coming up with what CPT codes I should use for this surgery 27488, 29874, 29876, etc. - I am just not sure which of these if any!

The patient was brought to the operating room theater, placed supine upon the operating room table after satisfactory general endotracheal anesthesia was administered. A bump was placed beneath the left hip. A time out was carried out and confirmed operative site with the operative consent. Preoperative antibiotics were given. A tourniquet was applied to the left upper thigh. A left lower extremity was then prepped and draped in the usual meticulous sterile fashion from mid thigh to the ankle. The operating room was set up for arthroscopic evaluation, irrigation, and debridement. After meticulous sterile prepping and draping, a culture of the knee joint was obtained and the failed polyethylene patellar component which had migrated to the subcutaneous tissues and eroded through the soft tissues was evaluated. A suprapatellar lateral portal was placed for outflow and an anterolateral portal was placed. The arthroscope was passed into the knee joint and the knee joint was irrigated with Neomycin fluid. The polyethylene component was visualized and the medial parapatellar wound was lengthened. This allowed for retrieval of the component. This was passed off the field and the soft tissues of the wound were then debrided sharply full thickness from skin to the deep tissues and bone of the patella. After thorough debridement, the knee joint was evaluated and this area plugged to allow for debridement with 3.5 full radius resector. This was utilized to perform a synovectomy that was hypertrophied in the medial compartment, lateral compartment and suprapatellar pouch. The bony bed of the patella was visualized and any synovium overgrowth was excised as well. The knee was irrigated with 12 liters of fluid and the knee was then examined in the polyethylene of the total knee showed signs of wear. However, the femoral component and the tibial baseplate were without significant scratches or trauma. Once the synovectomy was performed, the wound was closed and a Hemovac drain was placed. The wound was closed with 2-0 nylon and the portals were then closed with staples. The knee was then dressed with Xeroform, 4 x 4's, bulky knee dressing placed and knee immobilizer. The patient was returned to recovery and tolerated the procedure well without complications.

Any suggestions would be great!

Thanks,

Jodi
 
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