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Thread: Multiple Chondroplasties Knee

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    Default Multiple Chondroplasties Knee

    AAPC: Back to School
    Hi fellow coders - hope everyone had a nice Valentine's Day!!

    Coding chondroplasties in multiple compartments of the knee still eludes me - if anyone can help I would greatly appreciate it - -

    Diagnosis coding in this scenario would be helpful with regard to the medial and lateral femoral chondroplasties - how do you delineate?

    Thank you so VERY much!!

    POSTOPERATIVE DIAGNOSES: Right knee osteochondral defects, medial and
    lateral femoral condyle, patella, as well as multiple loose bodies, as
    well as ganglion cyst.

    PROCEDURES PERFORMED: Right knee arthroscopy with the following.
    1. Chondroplasty patella.
    2. Chondroplasty, medial femoral condyle.
    3. Chondroplasty of lateral femoral condyle.
    4. Removal of multiple loose bodies greater than 5 mm.
    5. Excision of prepatellar ganglion cyst.

    DESCRIPTION OF OPERATIVE PROCEDURE: The patient was met in the preoperative area. His right knee was signed after site and side confirmation. He was brought to the operating room, underwent general anesthesia. His right knee was prepped and draped in a standard sterile fashion. Timeout was performed identifying the right knee as
    the correct knee. The patient did receive 2 g of IV Kefzol. Under needle localization and Marcaine infiltration, a lateral parapatellar portal was made. Arthroscope was introduced into the patellofemoral joint. Diagnostic arthroscopy revealed multiple loose bodies, some
    measuring up to 2 cm in diameter. The knee was flexed down. There appeared to be grade 4 changes on the trochlea. There were grade 3 and 4 changes on the patella, as well as large osteochondral defect, as well as a large suprapatellar pouch osteophytes. The knee was flexed down to 90 degrees and brought into the medial compartment.
    Under needle localization and Marcaine infiltration, a medial parapatellar portal was made. The patient was noted to have grade 4 changes on the tibial plateau, grade 3 changes on the medial femoral condyle, as well as large osteochondral defect, as well as
    cartilaginous flaps. Using a shaver, the cartilaginous flaps were debrided back to a stable state with formal chondroplasty being performed. The ACL appeared intact, although there appeared to be a significant ligamentous notch off the medial femoral condyle. The
    lateral compartment was viewed with the leg in a figure-of-four position. There appeared to be again osteochondral defects of the lateral femoral condyle. Chondroplasty was performed using a shaver. Any loose pieces of cartilage were removed and it was thoroughly drained and re-insufflated. The scope was brought into the prepatellar joint, where multiple loose bodies were removed using a regular grasper, followed by a very large loose body, which could not be removed through standard portals and was found in the lateral gutter. A small lateral suprapatellar pouch portal was made and, using a Schmidt, the loose body was delivered from the body. This loose body measured approximately 2 cm x 2 cm x 1 cm thick. Once all this had been done, formal chondroplasty abrasion on the patella and trochlea were performed on any inhibiting osteophytes. The knee was thoroughly irrigated and drained. Portals were closed using 3-0 Monocryl. There was a small prepatellar cyst noted preoperatively in the medial aspect of the patella. A small skin incision was carried out under Marcaine infiltration, the cyst was identified, dissected free. It appeared to have a stalk dissecting down into the level of
    the knee capsule. This was found and bovied and closed appropriately. The cyst was removed and sent to pathology for identification as synovial cyst. That incision was closed using 2-0 Vicryl and then followed by subcuticular Monocryl. Dry sterile dressing was applied. The patient's knee was infused with a combination of 0.25% Marcaine with epinephrine.
    Last edited by Desperate Denise; 03-01-2011 at 06:33 AM.

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