bmeech
Networker
I just seem to think there is a code other then unlisted for this procedure. The Scope code would be 29879, the closest Open I am seeing is a 27415 or 27416 but that is with a Graft, I have also read that due to the defect / fragments it could be a fracture. (ORIF) But I just seem to think that is stretching it a bit...Any Suggestions???
PREOPERATIVE DIAGNOSIS: Right knee osteochondral defect medial femoral condyle.
POSTOPERATIVE DIAGNOSIS: Right knee osteochondral defect medial femoral condyle.
OPERATION/PROCEDURE PERFORMED
1. Right knee diagnostic arthroscopy.
2. Right knee open osteochondral defect (OCD) repair.
ANESTHESIA: General.
SURGEON:
ASSISTANT:
IMPLANTS USED: Arthrex headless compression screws.
HISTORY OF PRESENT ILLNESS: The patient is an 18-year-old male who has had a previous OCD on his left knee, underwent repair, and recovered very well from this. He developed pain in the right knee with swelling. An MRI scan showed a large, unstable osteochondral defect. Discussed treatment alternatives. Recommended fixation.
PROCEDURE: The patient was seen in the preoperative holding area. The consent form was reviewed. Surgical site was identified and marked with a permanent marker. He was given preoperative antibiotics, and then brought back to the operating room, placed supine on the operating room table. After induction of general anesthesia his right lower extremity was prepped and draped in the usual sterile fashion. A time-out was taken prior to beginning the procedure. I began by making standard arthroscopy portals including an inferomedial and inferolateral portal. I placed the camera into the inferolateral portal and began the diagnostic portion of the procedure. The suprapatellar pouch was visualized. There were no loose bodies seen. The patellofemoral joint was visualized. The patella tracked normally within the trochlea. There was no degenerative change seen. The medial and lateral gutters were visualized. There were no loose bodies seen. The medial compartment was visualized. The medial meniscus was intact. He did have a large osteochondral defect about 2 x 2 cm that was unstable. It was still sitting in the appropriate location, but it was completely unstable. The intracondylar notch was visualized, the ACL was intact. The lateral compartment was visualized. There was no arthritic change seen, no cartilage injury, and no meniscal tear. I then removed the arthroscopy equipment. I made a medial incision and a medial peripatellar arthrotomy and subluxed the patella just slightly laterally, and identified the fragment. I used curets to freshen the subchondral bone on the undersurface of the fragment, as well as on the femur itself and then reduced the fragment into place. I placed 3 headless compression screws, which had good compression of the fragment. I tried to place a 4th headless compression screw, and the shaft of the screw broke after it was already seated, so I removed just the proximal portion. The remainder I left in place. Irrigated the wound, was satisfied with the overall reduction and the alignment, and began closure. I closed the medial retinaculum with interrupted #1 Vicryl suture, subcutaneous tissues closed with interrupted 3-0 Vicryl suture. Skin was closed with a running 4-0 Monocryl suture. A sterile dressing was applied and a knee immobilizer. He was returned to the recovery room in stable condition.
PLAN: He will be discharged home today nonweightbearing on his right lower extremity. He will begin physical therapy next week.
PREOPERATIVE DIAGNOSIS: Right knee osteochondral defect medial femoral condyle.
POSTOPERATIVE DIAGNOSIS: Right knee osteochondral defect medial femoral condyle.
OPERATION/PROCEDURE PERFORMED
1. Right knee diagnostic arthroscopy.
2. Right knee open osteochondral defect (OCD) repair.
ANESTHESIA: General.
SURGEON:
ASSISTANT:
IMPLANTS USED: Arthrex headless compression screws.
HISTORY OF PRESENT ILLNESS: The patient is an 18-year-old male who has had a previous OCD on his left knee, underwent repair, and recovered very well from this. He developed pain in the right knee with swelling. An MRI scan showed a large, unstable osteochondral defect. Discussed treatment alternatives. Recommended fixation.
PROCEDURE: The patient was seen in the preoperative holding area. The consent form was reviewed. Surgical site was identified and marked with a permanent marker. He was given preoperative antibiotics, and then brought back to the operating room, placed supine on the operating room table. After induction of general anesthesia his right lower extremity was prepped and draped in the usual sterile fashion. A time-out was taken prior to beginning the procedure. I began by making standard arthroscopy portals including an inferomedial and inferolateral portal. I placed the camera into the inferolateral portal and began the diagnostic portion of the procedure. The suprapatellar pouch was visualized. There were no loose bodies seen. The patellofemoral joint was visualized. The patella tracked normally within the trochlea. There was no degenerative change seen. The medial and lateral gutters were visualized. There were no loose bodies seen. The medial compartment was visualized. The medial meniscus was intact. He did have a large osteochondral defect about 2 x 2 cm that was unstable. It was still sitting in the appropriate location, but it was completely unstable. The intracondylar notch was visualized, the ACL was intact. The lateral compartment was visualized. There was no arthritic change seen, no cartilage injury, and no meniscal tear. I then removed the arthroscopy equipment. I made a medial incision and a medial peripatellar arthrotomy and subluxed the patella just slightly laterally, and identified the fragment. I used curets to freshen the subchondral bone on the undersurface of the fragment, as well as on the femur itself and then reduced the fragment into place. I placed 3 headless compression screws, which had good compression of the fragment. I tried to place a 4th headless compression screw, and the shaft of the screw broke after it was already seated, so I removed just the proximal portion. The remainder I left in place. Irrigated the wound, was satisfied with the overall reduction and the alignment, and began closure. I closed the medial retinaculum with interrupted #1 Vicryl suture, subcutaneous tissues closed with interrupted 3-0 Vicryl suture. Skin was closed with a running 4-0 Monocryl suture. A sterile dressing was applied and a knee immobilizer. He was returned to the recovery room in stable condition.
PLAN: He will be discharged home today nonweightbearing on his right lower extremity. He will begin physical therapy next week.
