Knee Surgery
Tis is the physicians report. I began by localizing portals with 1% lidocaine. I then incise my lateral working portal, introduced the arthroscope into the knee joint. The knee joint was insufflated and a diagnostic arthroscopy was carried out. It was immediately apparent that the patient would not tolerate knee arthroscopy under local MAC and she was converted to general anesthesia. I then proceeded to continue my diagnostic arthroscopy. There was a significant amount of plica and adhesion formation in the suprapatellar pouch. The patellofemoral joint showed grade 3 chondromalacia changes of the patella and trochlea, with some loose chondral flaps noted. The gutters were clean.Lateral compartment was clean.The ACL was intact.There was a large osteochondral loose body in the notch anterior medially that was impinging in extreme extension. The medial compartment was then examined.There was a complex tear of the posterior horn of the medial meniscus, grade 4 changes of the tibial plateau and grade 3 changes, with some loose chondral edges with some loose chondral edges on the medial femoral chondral. I then localized my medial portal with a spinal needle, incised it and introduced my instruments through this. I then carried out a partial medial menisectomy with a combination of an arthroscopic shaver and biters back to a stable edge. The loose chondral flaps on the medial compartment were cleaned up. I then proceeded to introduce a shaver into the notch and excise the loose body that was in this region. I then introduced the scope and tools up into the patellofemoral joint and proceeded to carry out a chondroplasty of the trochlea as well as both facets of the patella.All loose chondral edges were taken back to a stable shoulder.The suprapatellar pouch was then examined and the adhesions and plica formations that were in the suprapatellar pouch tethering the patella were then resected. After this the patellofemoral joint opened up nicely. I proceeded to irrigate the wound with the remainder of the arthroscopic irrigant.The knee joint was evacuated. Ten cc of 1% lidocaine was injected in the knee through the scope for pain control.The scope was withdrawn.
What do you make of this? What codes and modifiers would you use? Do you code a new procedure everytime ther ia a new portal? I know that a diagnostic arthroscopy is part of a more major procedure. This is why I wondered if you knew of any instructional aides or camps that would benefit me? It is hard to find ortho camps.The one that you mentioned, did not have an ortho camp.Thanks for yor help...Kathy