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Thread: Knee Arthroscopy - Open Loose Body Removal - Help

  1. #1

    Default Knee Arthroscopy - Open Loose Body Removal - Help

    AAPC: Back to School
    29881 - Medical Meniscectomy
    G0289 - Chondroplasty Patellofemoral Comp
    G0289/59 - Chondroplasty Lateral Comp
    27331/59 - Open Removal of loose body(Add Dx V64.43)

    Operative note below. Above codes was what I was thinking of coding, but wanted another opinion about the Open removal before I do - New to Orthopedics and havent come across a situation like this yet. Thanks to all that respond!

    1. Right knee arthroscopy.
    2. Partial medial meniscectomy.
    3. Chondroplasty and debridement of all 3 compartments.
    4. Arthroscopic with a mini open removal of a very large 2 cm x
    1.5 cm to 2 cm loose body as well as removal of smaller loose

    I initially started medially where he had a very
    macerated torn medial meniscus, and in the face of advanced
    degenerative changes including the fact that you could see the
    metal staple posteromedially on the tibia. It was very stable
    and not moving but that will be removed when he eventually has a
    knee replacement. I initially performed resection of the torn
    medial meniscal tissue using a shaver. After the medial
    meniscectomy was performed, we actually had a small loose body
    under the patella more anteriorly which was arthroscopically
    removed with a grasper. This was in the range of about 5 mm or
    so to 6 mm perhaps. I then performed a chondroplasty and
    debridement of both the lateral compartment as well as the
    patellofemoral compartment where he had a lot of unstable
    cartilage flaps and defibrillation on both the patellar side as
    well as the trochlear side with osteophytes. After this was
    complete, his arthritis was still bent onto the patella. I did
    make a superior lateral portal in order to visualize the entire
    suprapatellar pouch. This was made, and the scope was placed
    superiorly. There was a tremendous amount of scar tissue as well
    as smaller loose bodies that could be seen, and then I saw the
    very large loose body which was very large which was free
    floating in the suprapatellar pouch area. I had to make a medial
    portal, and initially I performed a debridement of the
    suprapatellar pouch to remove the scar tissue very carefully, and
    then the loose bodies were arthroscopically removed; however, the
    larger loose body was so big I had to make a small incision over
    the patient's prior scar which is approximately 2 cm to 3.5 cm.
    I was then able to take a hemostat and removed the large loose
    body, and this was placed into a specimen cup. I then flushed
    out the rest of the knee. Again, I basically tried to clean up
    everything that could be debrided within the joint, but certainly
    he is going to need a knee replacement.

  2. #2


    Looks good to me!!

  3. #3


    Yes. It looks good. code the same as you mentioned.

    Good luck
    Rajesh Verma

  4. #4
    Join Date
    Apr 2007
    Greater Pittsburgh


    I disagree, I would bill 29881-medial; G0289-59-lateral; then 27331-w the v6443 because you performed a scope converted to an open procedure in the anterior(patellofemoral/suprapatellar) compartment.
    jdemar, CPC, CMA

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