Second opinion on surgery codes 27405 x2 and 27403


Virginia Beach, VA
Best answers
Second opinion on surgery codes 27405 x2 and 27403

1. Right knee open medial collateral ligament repair.
2. Opened medial patellofemoral ligament repair.
3. Open medial meniscus repair.

An EUA was performed that showed his medial side was a grade 3
injury with patellar instability. His lateral side was stable, his PCL was
normal. He had a grossly positive Lachman and we had discussed preop about
doing everything but due to his severe medial sided injury, we elected to his
medial side first because we thought it would be too high risk of
arthrofibrosis and we did the ACL as well. His leg was exsanguinated with an
Esmarch tourniquet after his leg was prepped and draped in appropriate sterile
fashion and a stop check was performed. An 8-cm incision was made over the
medial side. There was a large area of hematoma that was evacuated and pulse
lavaged and basically his whole medial side was just torn apart and the ends of
the MCL were not even close to one another. He had torn off the deep as well
as the superficial MCL as well as the MPFL as well as the posterior oblique
ligament and capsule. I initially identified all of the structures and then
very carefully started putting everything back anatomically. The MPFL avulsion
was identified. I put a 5.5 BioComposite Anchor from Arthrex at the medial
epicondyle and MPFL insertion where it was avulsed and this was repaired back
with 2 sutures and then I identified the ends of the MCL, for which Krakow
stitches were placed in both. I also went from deep to superficial. I placed
a total of 5 Juggernaut anchors into the tibia below the joint and the medial
meniscus was torn off the tibial side as well, which was repaired back with the
coronary ligaments using the stitches as well as deep MCL was repaired as well,
and then I repaired the superficial MCL, the posterior oblique ligament and
posterior capsule, which was completely torn part, was also repaired. I used a
lot of 0 Vicryl sutures and as I did the case, I made sure that he came to
complete full extension so that we did not perform a capsulorrhaphy of the
posterior capsule and tighten it too much and I did not. I was extremely
careful of the neurovascular structures. I actually dissected out the
saphenous nerve to make sure that was not injured since it was clear once going
into the hematoma. When I had repaired everything, his MCL felt quite stable.
When I was done, it looked good, and then I let the tourniquet down. His
patella was very stable. His medial side was stable and a drain was placed
deep. I obtained meticulous hemostasis but I just wanted to place a drain
since he had such a large hematoma under the skin even before the surgery. The
skin was closed in layers with 0 Vicryl, 2-0 Vicryl, subcu Monocryl, Dermabond
and Steri-Strips. He was placed in his knee immobilizer. He had a good pulse
postop and was brought to recovery where he is going to be admitted. I talked
to his mother about the pros and cons of different DVT prophylaxis and we have
elected to use aspirin, foot pumps on the floor and mobilization, especially
with the large amount of hematoma and bleeding he had from his injury. That is
part of why I did not put him on Xarelto or something other than the aspirin
and foot pumps because of the risk of bleeding