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Total Knee with recession ACL

  1. #1
    Default Total Knee with recession ACL
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    I have never seen this one before, and I am new to Ortho, so if you can help, thank-you!

    Procedure Performed: Right total knee replacement with full lateral release of collateral ligaments, recession anterior cruciate ligament, and fractional lengthening of the iliotibial band, right knee.

    In the operative note, the doc states this: I first performed a release of the lateral collateral ligaments by a sub periosteal dissection over the lateral tibial tuberosity. I released the posterior capsule and elevated this off of the femur using an elevator. Then, this was still too tight. I recessed the posterior cruciate ligament off the femur. Again, it was still tight, and it seemed to be in the IT band. I then sectionally lengthened the IT band. At this point, the ligamentous balance was deemed quite good. I was able to use a 12mm, which resulted in appropriat tension medially. The knee flexed easily, but the extension was still lacking about 10 degrees passively. I had released the capsule, and therefore I felt this was likely just tightness in the hamstring musculature from many years of not straightening. Therefore, this was felt to be appropriate.

    This only demonstrates the part of the op note where I am not sure what to code, The remainder is a standard knee replacement.

    I know I need to use 27447, but I'm not sure which other codes to use? would I use a 27425 for the lateral release? And I have no idea on the others. Thanks for the help! I sincerely appreciate it!

  2. Default
    The Coder's Desk Reference says that "The physician may release soft tissues and/or ligaments in order to correct deformities and improve range of motion."

    I'd think an insurance company would call it inclusive...
    Bruce Crandall, CPC
    North Carolina Specialty Hospital
    Durham, NC

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