Wiki Knee surgery-Doctor wants

[kathy a]

Doctor wants me to charge procedure codes #29881,#29877,#29875 and #29874. I feel that I can only code #29881 and #29874.Someone please help.Also if anyone could recommend any good ortho books, camps, etc. so I could learn some things. I ended up with ortho coding when someone was fired, and am trying to learn on my own. I would appreciate any in put. Thanks....Kathy

 

[scooter1]

Can you post some of the operative report ? Will need more info in order to help you.

Also HCPro has certified coder boot camps that are terrific. They are 5 days. Just google
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[kathy a]

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

 

[amartinez1]

To my understanding it sounds according to op report that you can only code for the 29881 and 29877. The physician did not mention how big the loose body was in order to code it seperate and i believe the plica and adhesion resection is included with the chondroplasty according to aaos(american academy of orthopedic surgeons) as far as orthopedic training courses not sure i am trying to find one as well but was told that the aaos has a coding book called complete global service data for orthopedic surgery through the aaos. It's a little pricy so i couldn't tell you if it works or not but i have had some other coders send me excerpts from the book and it does look like it will help you.

 

[kathy a]

Knee Surgery

The report states that there was a large osteochondral loose body.Does the surgeon also have to give the size of it?Also when I went on code correct and put the codes in for this surgery it states that #29877 and #29874 cannot be billed using any modifiers-that why I thought #29881-LT and #29875-LT is what should be billed??I wasn't sure if it should be billed with a 51 or 59 modifier??