Billingandcoding2
Contributor
For the below op report I was given CPT Codes 29914, 29916, and 29863. 29863 is bundled with the other two codes per NCCI edit. I am not sure if it would be reportable with modifier 59, it looks like the debridement of the synovial tissue is along the labrum which would be included in the repair of the labral tear?
Anesthesia: General
Pre-op Diagnosis: R hip femoracetabular impingement, labral tear
Post-op Diagnosis: Same + right hip moderate-severe synovitis
Procedure(s) performed:
Estimated Blood Loss: less than 50 ml Transfused: No
Traction time (post-less): 40min @150 lbs-f
Complications: none
Implants/Specimen: Stryker nano tak x2
Technique/Procedure Description:
Patient was met in the preoperative holding area and the operative limb was signed. I discussed the risks benefits alternatives and details of surgery as well as the postoperative care with the patient. They understand the concept of surgery and the postoperative conditions required for healing. They further understand that surgery and recovery can be unpredictable and the possibility is present to have unfavorable outcomes; In particular we discussed possible local complications of infection requiring further surgery or removal of tissue and implants, nonhealing of tissue, re-injury, the need for reoperation, instability, nerve injury, massive infection resulting in loss of tissue, loss of limb, or a bad outcome with continued or worsening pain as well as unforeseen unanticipated problems including severe disability or poor function. We discussed life-threatening complications including stroke blood clot pulmonary embolism and even death related to surgery or anesthesia or other factors. They understand the nature of their condition, the expected post operative outcomes as well as the conditions required and expectations for recovery. Patient understand these risks of the procedure and they are willing to proceed.
Patient was placed in supine positioning after administration of general anesthesia. All bony prominences were well padded. Preop abx were given and an appropriate time out was held identifying the patient, operative limb, procedure to be performed and any potential implants. The operative limb was prepped and draped in normal sterile fashion.
Traction resulting in subluxation of the hip joint was performed via the stryker gardian table. A standard anterolateral portal was established with outside-in technique using a long spinal needle, followed by establishment of an anterior portal. This was kept lateral to the ASIS. An intra-portal capsulotomy was performed with a cautery device in combination with samari blade. The hip was examined beginning with the central compartment which showed intact acetabular cartilage in all places except partial moderate (4-Smm) delamination along the acetabular rim primarily from 11 to 3 o clock. Along this region, the labrum showed sagging into the joint and partial separation from the acetabular rim. There was a section of intra-substance tearing from 12:30-2. There was moderate adjacent synovitis, this was debrided gently with shaver and cautery. This was done along the la bra I tear extending from the lateral to central and then medial compartments. The cartilage of the femoral head was healthy. The posterior labrum showed mild contrecoup injury but with out tear. The capsule was freed with a cautery along the acetabular rim above the labral tearing. A burr was used to decorticate the acetabular rim along the region of tearing. Care was taken to try to preserve the intact chondrolabral connections. 2 anchors were placed at 12:30, 1 ;30 positions with sutures passing through the labrum in mattress fashion and elevating it back out of the joint to the acetabular rim in an anatomic position. This recreated the suction seal of the hip joint and repaired the la bra I tearing well. A small portion of chondrolabral tissue which was loose and non viable was removed. The ligamentum teres was normal. The joint was leveraged to remove loose bone.
Traction was let off. I turned my attention to the peripheral compartment where I marked the head neck junction of the cam lesion on dynamic fluoroscopy. The head neck was rounded out, removing -3-4mm {at max depth) of cortical bone being careful not to remove cancellous bone. The osteochondroplasty/femoroplasty was performed on multiple views of fluoro including degrees of flexion and IR/ER. The rounding was completed down to the femoral neck. Dynamic examination in flexion/lR/ER showed -1 mm clearance of the femoral neck under the labrum, but maintained suction seal in extension. Once completed, the gutters were suctioned of any bony debris. I brought the hip to 1 Sdgr flexion and perfumed a capsular closure with 4 1.4mm tapes in simple stitch fashion. A spinal needle was placed above the capsule then the portals were closed with 3-0 monocryl and 3-0 nylon. 30cc of 1/4% bipivicaine w/o epi was then injected to perform a pericapsular block.
All counts were correct. Patient was awaken from anesthesia or sedation and taken to PACU in stable condition.
Anesthesia: General
Pre-op Diagnosis: R hip femoracetabular impingement, labral tear
Post-op Diagnosis: Same + right hip moderate-severe synovitis
Procedure(s) performed:
- Right hip arthroscopic labral repair
- Right hip arthroscopic femoroplasty
- Right hip arthroscopic debridement/synovectomy
Estimated Blood Loss: less than 50 ml Transfused: No
Traction time (post-less): 40min @150 lbs-f
Complications: none
Implants/Specimen: Stryker nano tak x2
Technique/Procedure Description:
Patient was met in the preoperative holding area and the operative limb was signed. I discussed the risks benefits alternatives and details of surgery as well as the postoperative care with the patient. They understand the concept of surgery and the postoperative conditions required for healing. They further understand that surgery and recovery can be unpredictable and the possibility is present to have unfavorable outcomes; In particular we discussed possible local complications of infection requiring further surgery or removal of tissue and implants, nonhealing of tissue, re-injury, the need for reoperation, instability, nerve injury, massive infection resulting in loss of tissue, loss of limb, or a bad outcome with continued or worsening pain as well as unforeseen unanticipated problems including severe disability or poor function. We discussed life-threatening complications including stroke blood clot pulmonary embolism and even death related to surgery or anesthesia or other factors. They understand the nature of their condition, the expected post operative outcomes as well as the conditions required and expectations for recovery. Patient understand these risks of the procedure and they are willing to proceed.
Patient was placed in supine positioning after administration of general anesthesia. All bony prominences were well padded. Preop abx were given and an appropriate time out was held identifying the patient, operative limb, procedure to be performed and any potential implants. The operative limb was prepped and draped in normal sterile fashion.
Traction resulting in subluxation of the hip joint was performed via the stryker gardian table. A standard anterolateral portal was established with outside-in technique using a long spinal needle, followed by establishment of an anterior portal. This was kept lateral to the ASIS. An intra-portal capsulotomy was performed with a cautery device in combination with samari blade. The hip was examined beginning with the central compartment which showed intact acetabular cartilage in all places except partial moderate (4-Smm) delamination along the acetabular rim primarily from 11 to 3 o clock. Along this region, the labrum showed sagging into the joint and partial separation from the acetabular rim. There was a section of intra-substance tearing from 12:30-2. There was moderate adjacent synovitis, this was debrided gently with shaver and cautery. This was done along the la bra I tear extending from the lateral to central and then medial compartments. The cartilage of the femoral head was healthy. The posterior labrum showed mild contrecoup injury but with out tear. The capsule was freed with a cautery along the acetabular rim above the labral tearing. A burr was used to decorticate the acetabular rim along the region of tearing. Care was taken to try to preserve the intact chondrolabral connections. 2 anchors were placed at 12:30, 1 ;30 positions with sutures passing through the labrum in mattress fashion and elevating it back out of the joint to the acetabular rim in an anatomic position. This recreated the suction seal of the hip joint and repaired the la bra I tearing well. A small portion of chondrolabral tissue which was loose and non viable was removed. The ligamentum teres was normal. The joint was leveraged to remove loose bone.
Traction was let off. I turned my attention to the peripheral compartment where I marked the head neck junction of the cam lesion on dynamic fluoroscopy. The head neck was rounded out, removing -3-4mm {at max depth) of cortical bone being careful not to remove cancellous bone. The osteochondroplasty/femoroplasty was performed on multiple views of fluoro including degrees of flexion and IR/ER. The rounding was completed down to the femoral neck. Dynamic examination in flexion/lR/ER showed -1 mm clearance of the femoral neck under the labrum, but maintained suction seal in extension. Once completed, the gutters were suctioned of any bony debris. I brought the hip to 1 Sdgr flexion and perfumed a capsular closure with 4 1.4mm tapes in simple stitch fashion. A spinal needle was placed above the capsule then the portals were closed with 3-0 monocryl and 3-0 nylon. 30cc of 1/4% bipivicaine w/o epi was then injected to perform a pericapsular block.
All counts were correct. Patient was awaken from anesthesia or sedation and taken to PACU in stable condition.
