need help 29898 ?

codedog

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______Need helpwith this one. Would cpt codes 29898 AND 29895 be a good choice ?Someone else suggest 29891 not sure if I agree
What dx would you choose. 732.7 ?

POSTOPERATIVE DIAGNOSES: Right ankle impingement plus medial tibial osteochondral defect measuring 1 x 1.5 cm.
PROCEDURES PERFORMED: Diagnostic right ankle arthroscopy, extensive debridement of the right ankle including debridement of medial and lateral gutters and synovectomy, and microfracture of the medial tibial plafond chondral defect.
PROCEDURE IN DETAIL:
female with persistent mechanical right ankle pain, failed to improve with conservative modalities. After appropriate consent was obtained, the site was marked, and preoperative antibiotics were given. She was brought to the operating suite. General anesthesia was instituted without difficulty. Her right lower extremity was prepped and draped in the normal sterile fashion. Tourniquet was inflated to 250 mmHg. Standard medial and lateral arthrotomy portals were made after the landmarks were identified and 10 pounds of traction was applied to the ankle. An incision was made with a #15 blade superficially; blunt dissection with a hemostat into the joint after it was injected with 15 cc of sterile normal saline. The blunt arthroscope was inserted into the joint without difficulty. There is noted to be a copious amount of scar tissue and meniscoid tissue in the medial gutter. There is also noted to be a 1.5 cm area of void articular cartilage of the anterior and medial tibial aspect of the joint. Lateral portal was established under direct visualization and blunt dissection with a hemostat. Shaver was used to débride the medial gutter and remove any of the meniscoid tissue from the gutter. Synovitis was also noted in the anterior aspect of the ankle joint, which was cleared away with the shaver, and the lateral gutter was also débrided with the shaver debriding all of the adhesions. Any loose articular cartilage was removed from the periphery of the chondral lesion.
Arthroscopic _____was used to perform a microfracture under direct visualization through medial portal while visualizing through the lateral portal. The posterior aspect of the ankle was visualized. The ligamentous structures appeared to be intact as was the syndesmosis. The ankle was injected with 0.25% plain Marcaine, closed with a 4-0 nylon suture, followed by a soft dressing. She tolerated the procedure well. All sponge and needle counts were correct at the end of the case and no complications.



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I would use 29891 for excision of the osteochondral defect and the drilling (microfracture) and also 29898-51 for the extensive debridement (for other than the index lesion). Hope this helps.
 

colham478

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Thank you for this post- 9 months later!! :d i had the exact same situation almost word for word. Lol! What are the chances of that?? :d
 
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