Wiki Knee Sx help please

[orthopaedic01]

Can someone please help with the knee sx.?
DX: Anserine bursitis left knee and scarred fat left knee
PROCEDURE: Excision of subcut. fat and decompression of anserine bursa with lysis of adhesions from the semitendinosus tendon.

DETAILS: Long. incision was made over the anteromedial aspect of the distal knee overlying the pes anserinus. Dissection was carried through subcut. tissue and there was seen to be a thickened scarred collection of subcut. fat in the region and this was what was responsible for the palpable mass. This fat was excised and sent to pathology. The tissue overlying the anserine bursa was divided and the superior edge of the gracilis was retracted thereby identifying the semintendinosus tendon. This was found to be scarred and adhered with a slight amount of inflammatory tissue present on its inferior surface. The scarring and inflammatory tissue was debrided. Wound was irrigated thoroughly and closed in layers.

I was thinking 27323 for the excision of the subcut. fat mass. Even though this is a biopsy code the lay terms state "incision is made over the biopsy area. Dissection is carried down within the superficial soft tissue layers in 27323, usually the subcutaneous fat to the uppermost fascial layer. A portion of the tissue is excised and submitted for pathology"

I was thinking of 27496 for the decompression of the anserine bursa...but just not sure.

As far as the debridement of the tendon, I don't have a clue. You can't use 29877 because that's debriding cartilage, not a tendon.

Any help/ideas would be most appreciated!

 

[AuntJoyce]

Pes Anserine Bursitis...

Good afternoon,

Not sure that I am going to be of much help but I will see what I can put together.

First, it seems to me that the surgeon was going in to deal with the pes anserine bursitis issue and when he opened the knee, he encountered the thickened fat. In my opinion, this was something he encountered along the way and so I would consider that just part of the overall procedure of the decompression. If you encounter a barricade in your travel to the intended target, you need to deal with it and you can't always charge for each "fork in the road". As for the lysis of the adhesions, the reason you would not go with 29877 mainly is because that is an arthroscopy code. Again, I might consider the lysis of the adhesions as inherent to the main procedure.

The main thing to remember when dealing with surgery on the knee is how many compartments are you working on...it appears that your doc mainly worked in the one targested compartment.

Since it is late in the day, I am attributing my not being able to find any better advise to that.

Hope this helps at least a little...

Joyce