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Thread: Multiple arthroscopic knee procedures

  1. #1

    Default Multiple arthroscopic knee procedures

    AAPC: Back to School
    Fellow coders:

    Can you please look at this opnote and tell me what you think?
    I coded 29881, 29824-59 G0289 (Blue Shield of Massachusetts).

    Also, can someone clarify which compartment the notch is in and which compartment the trochlea is in? I always get confused especially with thee types of procedures when he is in and out of all sorts of compartments.

    Thank you soooooo much!!


    PREOPERATIVE DIAGNOSIS: Left knee osteoarthritis with medial meniscal

    POSTOPERATIVE DIAGNOSIS: Left knee osteoarthritis with medial meniscal
    tear. Loose body/fragments > 5mm. Chondromalacia patella.

    OPERATION PERFORMED: Left knee arthroscopy. Partial synovectomy. Removal of loose body. Partial medial meniscectomy. Chondroplasty, patellofemoral joint and medial compartment.

    INDICATIONS FOR PROCEDURE: The patient is a 61-year-old male who has been having left knee pain with mechanical symptoms refractory to nonoperative intervention. X-rays revealed moderate degenerative changes. MRI revealed meniscus tear. The patient had mechanical symptoms. Therefore, he is indicated for surgery. The patient was aware of the limits of surgery, given the fact that he has osteoarthritis.

    DESCRIPTION OF PROCEDURE: The patient was taken to the OR and the left knee was identified as the correct operative site by the patient and
    signed by the surgeon. The left knee was shaved in the holding area. The
    patient was placed supine on the OR table. One gram of Ancef was given
    preoperatively within one hour of incision. The patient was administered
    local anesthetic with half of 1% Xylocaine with epinephrine and half of
    0.25% Marcaine with epinephrine. 50 cc were injected intra-articularly and
    20 cc were injected, split between the anterior medial and anterior
    lateral portal sites. The left knee was prepped and draped in the standard
    surgical fashion using a standard anterior lateral and anterior medial
    portal. These portal sites were made. Arthroscope was inserted. Diagnostic
    arthroscopy was started. There were noted to be end-stage degenerative
    changes in the trochlea in the middle and the medial aspect, there was
    noted to be grade 3-4 chondromalacia in the patella. Using a 4.5 curved
    incisor, synovectomy was performed and the chondroplasty was performed.
    Also, using ArthroCare wand on a low setting, chondroplasty was performed.
    Attention was directed towards the medial compartment. There were noted to be end-stage degenerative changes of the medial compartment. There was noted to be fraying of the remnant of the posterior horn and the anterior
    horn of the medial meniscus. This was debrided with a 4.5 curved incisor,
    as well as ArthroCare wand. The chondroplasty also performed, deriding the
    loose cartilage with the 4.5 curved incisor and ArthroCare wand. The notch
    was visualized. There was noted to be synovitis within the notch. It was
    debrided with the 4.5 curved incisor and ArthroCare wand. There was noted
    to be a very small loose body at the origin of the PCL. This was just
    excised with a 4.5 curved incisor. Lateral compartment was visualized. The
    ACL and PCL were noted to be intact. Stable lateral compartment was
    visualized with only mild grade 2 chondromalacia. In the lateral tibial
    plateau, noticed a lateral meniscal tearing. The knee was copiously
    irrigated. Excess fluid was suctioned out. Portal sites were closed with
    #4-0 nylon suture in a simple fashion. Sterile Xeroform dressing was
    placed on the left knee. The patient tolerated the procedure well an was
    taken to the recovery room in good and stable condition.

  2. #2
    Join Date
    Apr 2007


    The synovectomy and loose body in the medial compartment are inclusive of the meniscetomy. The loose body needs to be larger than 5mm if you want to bill it with a 59. You can bill a chondroplasty of the patella since it was in a different compartment. Unless your local BCBS accepts that G code (Michigan does not). I would try
    29877-59 (dx 717.7)
    29874-59 (dx 717.6)
    Good luck. I usually have to appeal with op note for manual review

  3. #3

    Default Malery

    Thank you so much - I figured billing for the removal of loose body would be okay because it was greater than 5mm.

    Have a great day!!


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