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Thread: Steroid Injections for toes?

  1. #1
    Join Date
    Apr 2007
    Coeur D'Alene, Idaho

    Default Steroid Injections for toes?

    AAPC: Back to School
    I have an Op Note from a Knee Scope procedure where the Dr. started off with steroid injections into her toes. It's unrelated to the Scope procedure, it was just something he did since he was there. Can we be reimbursed for that? Or at least the drugs used?

    The only code I came up with for injecting anything into toes was 20600, but I'm not sure it's accurate...Any other suggestions/advice? I copied the Op Report below.


    PREOPERATIVE DIAGNOSES: Lateral meniscus tear and patellofemoral chondromalacia.

    POSTOPERATIVE DIAGNOSES: Lateral meniscus tear and patellofemoral chondromalacia.

    PROCEDURE: Arthroscopic knee surgery, partial lateral meniscectomy, and chondromalacia of patella and femoral groove.


    INDICATION AND CONSENT: The patient is status post arthroscopic knee surgery on her other side. She had a lateral meniscus tear and significant chondromalacia of her patella. She underwent debridement of both and had excellent resolution. Because of similar symptomatology, she desires to have her opposite side done. We discussed options for care with her. We discussed the risks, complications, and alternatives. She understands and gave her consent to proceed.

    PROCEDURE: The patient was brought to the operating room where the timeout was done. Person, place, allergies, and antibiotics were all assured and confirmed. She was placed on the operating room table. Sedation was done.

    We had talked about, while I had her sedated, injecting her fourth and fifth metatarsal articulation because of pain she is having there with some arthritic changes. I did inject that joint with 0.50 cc,which equals 3 mg, of Celestone, and 0.50 cc of a 50/50 mixture of local Xylocaine and Marcaine. With that injection done, I proceeded to perform the three-portal injection of additional preemptive analgesia. When I had the three portals injected, I went ahead and had her prepped and draped.

    A standard three-portal arthroscopy was done. Her knee was stable at the anterior-posterior stress testing. As I looked inside the knee, I initially looked at the patellofemoral articulation. As expected, the patellofemoral articulation did have some narrowing at the superior-most aspect . As I got down to the curve of the femoral groove, it had completely lost its articular cartilage of the groove on the lateral side of the groove and in its deep interposition. The medial femoral condyle had articular cartilage present. The patella itself, on the superior half, had intact articular cartilage with some grade 2 chondromalacia. It then went down to a very smooth but definitive endpoint where the articular cartilage was completely worn off the inferior half. There was nothing on the femoral groove that needed debridement. However, the grade 2 chondromalacia of the superior pole of the patella had some unstable fragments that were shaved down. I did document that with pictures. With that accomplished, I brought my attention to the medial side where I expected no problems. There was small articular cartilage fringing but, by and large, had grade 1 chondromalacia of the medial side. The meniscus was probed and found to be intact throughout.

    Attention was then brought to the lateral side, and as expected, she had a very complex posterior lateral meniscus tear, and a very complex anterior horn meniscus tear too. Both were debrided off with baskets and shavers until I had a stable healthy rim. The articular cartilage on the lateral side of the knee was looked at as well. There were areas that were eburnated all the way down to bone, but a very small amount of her knee was down to bone. Most had grade 2 to 3 chondromalacia changes. Those changes were very easily and definitely smoothed down, so I had good articular cartilage remaining on the lateral side. With that accomplished, I did document the condition of the ACL and the structures of the knee. There was a lot of synovitis, especially in the gutters, but there were no loose bodies seen and removed. When I had all the shaving done on the lateral side of both posterior and anterior horns, I terminated the arthroscopy.

    After copious irrigation, the arthroscopic portals were closed with 5-0 nylon. Tega-Steries were placed over the tops of the wounds. I injected the knee with 10 cc of 0.50%% Marcaine without epinephrine and 1.5 cc of Celestone. The procedure was well tolerated. She had a sterile dressing applied and was brought to the recovery room in good condition. There were no complications.

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    20600 is correct
    Walker Bachman, CPC, CPPM

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