Knee Arthroscopy - Open Loose Body Removal - Help


Best answers
29881 - Medical Meniscectomy
G0289 - Chondroplasty Patellofemoral Comp
G0289/59 - Chondroplasty Lateral Comp
27331/59 - Open Removal of loose body(Add Dx V64.43)

Operative note below. Above codes was what I was thinking of coding, but wanted another opinion about the Open removal before I do - New to Orthopedics and havent come across a situation like this yet. Thanks to all that respond!

1. Right knee arthroscopy.
2. Partial medial meniscectomy.
3. Chondroplasty and debridement of all 3 compartments.
4. Arthroscopic with a mini open removal of a very large 2 cm x
1.5 cm to 2 cm loose body as well as removal of smaller loose

I initially started medially where he had a very
macerated torn medial meniscus, and in the face of advanced
degenerative changes including the fact that you could see the
metal staple posteromedially on the tibia. It was very stable
and not moving but that will be removed when he eventually has a
knee replacement. I initially performed resection of the torn
medial meniscal tissue using a shaver. After the medial
meniscectomy was performed, we actually had a small loose body
under the patella more anteriorly which was arthroscopically
removed with a grasper. This was in the range of about 5 mm or
so to 6 mm perhaps. I then performed a chondroplasty and
debridement of both the lateral compartment as well as the
patellofemoral compartment where he had a lot of unstable
cartilage flaps and defibrillation on both the patellar side as
well as the trochlear side with osteophytes. After this was
complete, his arthritis was still bent onto the patella. I did
make a superior lateral portal in order to visualize the entire
suprapatellar pouch. This was made, and the scope was placed
superiorly. There was a tremendous amount of scar tissue as well
as smaller loose bodies that could be seen, and then I saw the
very large loose body which was very large which was free
floating in the suprapatellar pouch area. I had to make a medial
portal, and initially I performed a debridement of the
suprapatellar pouch to remove the scar tissue very carefully, and
then the loose bodies were arthroscopically removed; however, the
larger loose body was so big I had to make a small incision over
the patient's prior scar which is approximately 2 cm to 3.5 cm.
I was then able to take a hemostat and removed the large loose
body, and this was placed into a specimen cup. I then flushed
out the rest of the knee. Again, I basically tried to clean up
everything that could be debrided within the joint, but certainly
he is going to need a knee replacement.


Greater Pittsburgh
Best answers
I disagree, I would bill 29881-medial; G0289-59-lateral; then 27331-w the v6443 because you performed a scope converted to an open procedure in the anterior(patellofemoral/suprapatellar) compartment.