I was thinking 27418 and 27422 am I right? or is only the 27418 billable?
Thank you in advance for your help???
POSTOPERATIVE DIAGNOSIS: Left knee recurrent patellofemoral instability.
OPERATIONS PERFORMED
1. Left knee arthroscopy.
2. Left knee Fulkerson procedure.
3. Left knee medial patellofemoral ligament reconstruction.
IMPLANTS USED: We used two Synthes 52 mm 4.5 cortical screws for fixation of the Fulkerson osteotomy. We used two Arthrex 4.75 mm swivel-lock anchors and one Arthrex Bio-Tenodesis screw.
DICTATION OF PROCEDURE: The patient was seen in the preoperative holding area, the consent form was reviewed, surgical site was identified and marked with permanent marker. She was given preoperative antibiotics and a regional block and then brought back to the operating room and placed on the operating room table. After induction of anesthesia her left lower extremity was prepped and draped in the usual sterile fashion. Timeout was taken prior to beginning the procedure. I began with a diagnostic arthrotomy, I made an inferolateral portal and placed the camera into the knee joint. The suprapatellar pouch was visualized, there were no loose bodies seen. The patellofemoral joint was visualized, the patella did have a lateral patellar tilt and tracked just somewhat laterally within the trochlear. She had a shallow trochlear groove and grade 1 chondromalacia and very slight grade 2 chondromalacia on the undersurface of the patella. There was no large cartilage defect. Medial and lateral gutters were visualized, no loose bodies seen. The medial compartment was visualized, there was no cartilage injury and no meniscal tear. The intercondylar notch was visualized, the ACL was intact. The lateral compartment was visualized, there was no meniscus injury or cartilage injury. I then removed the arthroscopy equipment. I then made a longitudinal incision centered over the tibial tubercle, incised sharply down through the skin, the dermis and the subcutaneous tissues and elevated soft tissue flaps. I then incised through the Sartorius fascia and harvested the gracilis tendon, this was then saved on the back table for later preparation by my assistant. I then performed Fulkerson osteotomy. I used an oscillating saw and osteotome to mobilize the tibial tubercle and medialize this 1 cm medially. I then stabilized this with two K-wires and then drilled and placed two 4.5 mm cortical screws, had good purchase with both screws, checked with C-arm, was satisfied with the position of the hardware, the length of the screws and the reduction of the osteotomy. My assistant then prepared the gracilis on the back table. I used two Guide Wires and drilled two tunnels for the swivel-locks and then sutured the gracilis graft into the two tunnels within the patella confirming with C-arm that they were in appropriate position. I then used the C-arm to get my starting point along the posterior aspect of the cortex and Blumensaat's line, overdrilled this and then passed the graft and secured this into the femur. I placed her knee through a full range of motion and there was no undue tension on the graft. She had a very stable patellar exam with only 1+ quadrant mobility and a solid endpoint that tracked very nicely within the trochlear. I irrigated and began closure. I closed the deep tissues with 3-0 Vicryl suture, skin was closed with Monocryl, sterile dressing was applied and a knee immobilizer, returned to the recovery room in stable condition.
Thank you in advance for your help???
POSTOPERATIVE DIAGNOSIS: Left knee recurrent patellofemoral instability.
OPERATIONS PERFORMED
1. Left knee arthroscopy.
2. Left knee Fulkerson procedure.
3. Left knee medial patellofemoral ligament reconstruction.
IMPLANTS USED: We used two Synthes 52 mm 4.5 cortical screws for fixation of the Fulkerson osteotomy. We used two Arthrex 4.75 mm swivel-lock anchors and one Arthrex Bio-Tenodesis screw.
DICTATION OF PROCEDURE: The patient was seen in the preoperative holding area, the consent form was reviewed, surgical site was identified and marked with permanent marker. She was given preoperative antibiotics and a regional block and then brought back to the operating room and placed on the operating room table. After induction of anesthesia her left lower extremity was prepped and draped in the usual sterile fashion. Timeout was taken prior to beginning the procedure. I began with a diagnostic arthrotomy, I made an inferolateral portal and placed the camera into the knee joint. The suprapatellar pouch was visualized, there were no loose bodies seen. The patellofemoral joint was visualized, the patella did have a lateral patellar tilt and tracked just somewhat laterally within the trochlear. She had a shallow trochlear groove and grade 1 chondromalacia and very slight grade 2 chondromalacia on the undersurface of the patella. There was no large cartilage defect. Medial and lateral gutters were visualized, no loose bodies seen. The medial compartment was visualized, there was no cartilage injury and no meniscal tear. The intercondylar notch was visualized, the ACL was intact. The lateral compartment was visualized, there was no meniscus injury or cartilage injury. I then removed the arthroscopy equipment. I then made a longitudinal incision centered over the tibial tubercle, incised sharply down through the skin, the dermis and the subcutaneous tissues and elevated soft tissue flaps. I then incised through the Sartorius fascia and harvested the gracilis tendon, this was then saved on the back table for later preparation by my assistant. I then performed Fulkerson osteotomy. I used an oscillating saw and osteotome to mobilize the tibial tubercle and medialize this 1 cm medially. I then stabilized this with two K-wires and then drilled and placed two 4.5 mm cortical screws, had good purchase with both screws, checked with C-arm, was satisfied with the position of the hardware, the length of the screws and the reduction of the osteotomy. My assistant then prepared the gracilis on the back table. I used two Guide Wires and drilled two tunnels for the swivel-locks and then sutured the gracilis graft into the two tunnels within the patella confirming with C-arm that they were in appropriate position. I then used the C-arm to get my starting point along the posterior aspect of the cortex and Blumensaat's line, overdrilled this and then passed the graft and secured this into the femur. I placed her knee through a full range of motion and there was no undue tension on the graft. She had a very stable patellar exam with only 1+ quadrant mobility and a solid endpoint that tracked very nicely within the trochlear. I irrigated and began closure. I closed the deep tissues with 3-0 Vicryl suture, skin was closed with Monocryl, sterile dressing was applied and a knee immobilizer, returned to the recovery room in stable condition.