Wiki Please Help With Surgical Knee Coding

[ortholg@yahoo.com]

My doctor states he did a Patella reconstruction (27422), a Chondroplasty (29877), a Loose body removal (29874), a Lateral release (29873), and a Limited synovectomy (29875) on a patient. As far as I can tell, the chondroplasty, the loose body removal, and the synovectomy are all included in the lateral release, so that isn't separately reportable. But then as I looked further it appeared that the Lateral release is included in the patella reconstruction.. So can I get someone to verify these things and if I'm correct in these inclusions, what does this mean? Does it mean my doc should only code for the Patella reconstruction? That seems like such a loss.

If that's too confusing, can someone simply tell me how they would code for the following codes in performed in one session, same knee. 27422, 29877, 29874, 29873, 29875

 

[maryanneheath]

My doctor states he did a Patella reconstruction (27422), a Chondroplasty (29877), a Loose body removal (29874), a Lateral release (29873), and a Limited synovectomy (29875) on a patient. As far as I can tell, the chondroplasty, the loose body removal, and the synovectomy are all included in the lateral release, so that isn't separately reportable. But then as I looked further it appeared that the Lateral release is included in the patella reconstruction.. So can I get someone to verify these things and if I'm correct in these inclusions, what does this mean? Does it mean my doc should only code for the Patella reconstruction? That seems like such a loss.

If that's too confusing, can someone simply tell me how they would code for the following codes in performed in one session, same knee. 27422, 29877, 29874, 29873, 29875

I think we need to see the operative report. You have open codes mixed with arthroscopic codes here, which isn't unheard of, but more info would be helpful.

 

[ortholg@yahoo.com]

Excerpt from o.r. Report

Thanks for the quick response! In answer to your response asking to for OR report, I am reading in it that he assessed the laxity/stability in both knees under anesthesia at first. Now I'll type in the pertinent part of his OR report. (see below)

"Standard anteromedial and anterolateral arthroscopic portals were made and arthroscopy was commenced. Upon entering the joint, the suprapatellar pouch was visualized. I could see signifcant chondromalacia on the undersurface of the patella as well as a chondral body that was hanging by a flap. I could see on the lateral retinacular area another chondromatosis type area that was attached to the capsule/synovium. There were two loose bodies, one in the medial gutter and one anteromedially. I removed the one on the meidial gutter pretty easily. I shaved away the two that were in the synovium as well as suction shaved away the smaller loose body. After those were removed, I then removed the anterior plica and all the anterior synovitis as well as a little bit of a fat pad both therapeutically and for visualization. I went into the lateral compartment and visualized the lateral articular cartilage. The articular cartilage on the tibial side had some grade 2 and 3 chondromalacia especially anteromedially. The meniscus itself was intact. The popliteus tendon was intact. There was some scattered diffuse 1 and 2 chondromalacia on the lateral tibial plateau, minimal on the lateral femoral condyle. I performed a chondroplasty of the lateral tibial plateau with the Turbowhisker. I then went into the medial compartment. I probed the medial meniscus throughout its superior and inferior surfaces. It was felt to be stable. There was some mild chondromalacia in the medial compartment on the posteromedial aspect of the tibia. I performed a chondroplasty and the remainder of the cartilage probably had mostly grade 1 or minimal-to-no chondromalacia on the rest of it. I then went up into the patellofemoral joint and performed an extensive chondroplasty of the extensive chondromalacia on the entire median ridge and medial facet of the patella. There was extensive lateral tilt to the patella looking through both portal sites. The lateral retinaculum was tight and the medial retinaculum was loose. After performing an extensive chondroplasty of the undersurface of the patella, I then looked posteriorly through the intercondylar notch with a 70 degree arthroscope to make sure there no loose bodies posteromedially and posterolaterally, which there were not. I then used the large curved harpoon type needle and going externally through the skin posteriorly and then coming out anteriorly going through the joint, through the retinaculum, starting at the femoral attachment of the capsule and then coming out near the patellar attachment of the capsule/retinaculum, I placed five #5 FiberWire sutures across the medial retinacular area. I then used the sabre 30 electrocautery wand and performed an arthroscopic lateral release. I coagulated the bleeders using the electrocautery. I then removed the scope and made a small medial incision about 3.5 cm in length halfway between the medial facet of the patella and the medial epicondyle. I then injected bluntly down into the capsule. I was able to fish out all of the sutures, pair them up and then while placing a medial force on the patella, I tied down and reefed up the medial capsule tying down all five of the #5 FiberWire sutures. I then placed the scope back in and clearly the patella had been brought over and centered more medially compared to being significantly lateralized and laterally tilted prior to tying down the retinaculum. I then placed a spinal needle under direct visualization into the suparapatellar pouch for later instillation of 20 cc of 0.5% Marcaine without epinephrine. The portal sites where closed with 3-0 Monocryl subuticular sutures and Steri-Strips. The mini-incision was closed with Vicryl 2-0 and staples, Xerolow, 4x4's ABDs, Kerlix, a double 6-inchAce wrap, and a knee immoilizer was utilized..." ​

So that's the procedure. He does say he did both a scope and an open procedure. So let me know what you think about coding this when you get time. Thanks so much. Again and again!