Wiki Traumatic knee arthrotomy I & D code?

[smfrickl]

I have recently started coding Trauma ortho and see a lot of traumatic knee arthrotomies so I am now struggling with my code choices of whether to use 27310 vs 27331 vs 11044. Can anyone please help me figure out which one best fits this situation? Here is the note...

6 L of irrigation solution was used to irrigate the 15 cm traumatic wound on the anterior aspect of the right knee the traumatic laceration also created a lateral parapatellar traumatic arthrotomy. The knee joint communicated to the outside. There is a great deal of foreign debris present the scalpel rongeurs and curettes were used to thoroughly debride skin subcutaneous tissue and bone of the lateral aspect of the patella which was comminuted of the superior lateral pole. After an extensive excisional debridement and thorough irrigation a large Hemovac drain was placed in the knee joint exiting superior laterally in the thigh proximally the traumatic arthrotomy was loosely approximated with 2-0 PDS. Skin was closed with 2-0 nylon in interrupted fashion. Hemovac was hooked up to its suction reservoir. Xeroform sterile dressing was applied to the knee with an Ace wrap.

 

[thomas7331]

In my opinion, 27310 and 27331 are not supported since the physician did not perform an arthrotomy - the arthrotomy here was caused by the injury and isn't documented as a procedure performed by the provider. 11044 doesn't capture the work of the closure of the joint space and skin - I think a more correct alternative would be a complex closure code, but an unlisted procedure 27599 may be worth considering in this situation since the procedure does involve the joint itself and not just the integumentary system.

 

[nickelclaw]

In my opinion, 27310 and 27331 are not supported since the physician did not perform an arthrotomy - the arthrotomy here was caused by the injury and isn't documented as a procedure performed by the provider. 11044 doesn't capture the work of the closure of the joint space and skin - I think a more correct alternative would be a complex closure code, but an unlisted procedure 27599 may be worth considering in this situation since the procedure does involve the joint itself and not just the integumentary system.

Agree with Thomas arthotomy not done was lacerated due to trauma. Would code as debriement bone 11044

 

[smfrickl]

Thank you both for responding. I have been seeing our trauma surgeons billing the knee arthrotomy codes for injuries where the joint is already open and started wondering if there was an exception for these trauma cases that I was unaware of. I do agree that 11044 meets what was done but like Thomas states, it doesn’t cover the work done in the joint. So I may go back to the surgeon to see what he thinks about an unlisted code.

 

[kcoyne1109]

just seeing what you had success with when billing this. One of my surgeons did this and wants to bill 27310, however the joint was open due to the injury. The complex closure doesn't capture the joint work.

 

[amyjph]

This is an old thread, but I still think I would report the 27310. While the joint may already be "open" they still had to go in to the joint and do the work of 27310. In some cases they might go into another compartment and the work described in 27310 is what they are doing here. I think it may depend on the extent of the injury and what exactly is documented. They may also make the wound bigger and go deeper in.
It also depends on what else is being done at the same site/time of surgery. I don't think this is a one size fits all type question/answer when it comes to trauma.