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microfracture technique in mcp joint?

  1. #1
    Default microfracture technique in mcp joint?
    Medical Coding Books
    my doctor performed what he labled a 'microfracture technique of the articular surface of the 3rd mcp joint'. he states "holes were drilled using a 45 k pin in the arthritic area and centrally, the mcp joint, multiple punctate holes for hopefully the regrowth of cartilage."

    can anyone help me with this code? to me it sounds like little more than arthrotomy so if anyone can clarify this better it would be appreciated.


  2. #2
    Amarillo Texas Chapter
    Hi...its not arthrotomy..its microfracture in...The microfracture procedure is done arthroscopically. The surgeon visually assesses the defect and performs the procedure using special instruments that are inserted through three small incisions on the knee. After assessing the cartilage damage, any unstable cartilage is removed from the exposed bone. The surrounding rim of remaining articular cartilage is also checked for loose or marginally attached cartilage. This loose cartilage is also removed so that there is a stable edge of cartilage surrounding the defect. The process of thoroughly cleaning and preparing the defect is essential for optimum results.

    Multiple holes, or microfractures, are then made in the exposed bone about 3 to 4mm apart. Bone marrow cells and blood from the holes combine to form a "super clot" that completely covers the damaged area. This marrow-rich clot is the basis for the new tissue formation. The microfracture technique produces a rough bone surface that the clot adheres to more easily. This clot eventually matures into firm repair tissue that becomes smooth and durable.

    So basically you would need to search for a code in the arthroscopic section of musculoskeletal system. I guess the closet code available would be 29902, unless there is some code in category III

  3. #3
    i'm sorry i should have mentioned that this wasn't done arthroscopically.
    the dx was for djd arthritis of the mcp joint.
    in the list of procedures he states: arthrotomy, ostectomy, synovectomy, capsulotomy and microfracture technique of articular surface of mcp jt. the report reads:

    incision made on the dorsal ulnar aspect of the mcp jt and the dorsal mechanism released and retracted, marked supr forming at mcp jt dorsally. spurs were removed dorsally. then there waws a protion of the articular surface that seemed to be resonably good except the central part which was markedly degenerative. this is the area after the capsulotomy, synovectomy, and partial release of the collateral so that the joint could be flexed over 90 degrees. then holes were drilled using a 45 k pin in the arthritic area and centrally, the mcp joint, multiple punctate holes for hopefully the regrowth of cartilage. once this was achieved then closure with 5-0 nylon.

    this is where i got confused because like you said and everything i looked up it states that this is done arthroscopically. so now i'm back to my question of how do i code what he labled as microfracture technique?

    thank you for the help.

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