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Arthroscopic debridement of postoperative hematoma

  1. Default Arthroscopic debridement of postoperative hematoma
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    Not really sure exactly what code I would use for this. If anyone has any suggestions that would be much appriciated. Thanks!

    POSTOPERATIVE DIAGNOSIS:
    Hematoma, left revision knee replacement.

    OPERATION PERFORMED:
    Arthroscopic debridement of postoperative hematoma.



    DESCRIPTION OF OPERATION:
    Once we had the scope in
    the 5.5 radius shaver, all set to go, a stab wound was made in
    the superolateral patella portal. The trocar was entered into
    the knee. We suctioned out as much we could, but of course, it
    clotted off quite readily. The 5.5 shaver was then inserted into
    the knee, placed under suction, and staying right beneath the
    patella area and the very large open area of the hematoma, we
    were able to shave out the hematoma. We went back and forth
    multiple times, re-irrigating the knee, flushing it out
    aggressively, manipulating the knee and the soft tissues around
    it to free up as much clot as possible. These were taken out
    without much difficulty. We went back and forth and ended up
    running a couple of liters of antibiotic solution through the
    knee while simultaneously removing all the clot. When we flexed
    the knee up, we could get it to about 100 degrees. Some hematoma
    was evacuated from the subcutaneous tissue through the staple
    line. By rolling along the staple line, we were able to get this
    hematoma out as well. When all was said and done and multiply
    irrigated the knee with antibiotic solution, sucked out all the
    clot that was possible, the knee actually looked quite more
    normal. It would basically bend passively to about 100 degrees.
    Happy with this, the portal was closed with 3-0 nylon suture.
    Big bulky dressing was applied as was a little bit of a
    compressive Ace bandage. A tourniquet was deflated. The patient
    was awakened and transferred to recovery room in stable
    condition.

  2. #2
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    Long Island/New York
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    Default
    Quote Originally Posted by sara82 View Post
    not really sure exactly what code i would use for this. If anyone has any suggestions that would be much appriciated. Thanks!

    Postoperative diagnosis:
    Hematoma, left revision knee replacement.

    Operation performed:
    Arthroscopic debridement of postoperative hematoma.



    Description of operation:
    Once we had the scope in
    the 5.5 radius shaver, all set to go, a stab wound was made in
    the superolateral patella portal. The trocar was entered into
    the knee. We suctioned out as much we could, but of course, it
    clotted off quite readily. The 5.5 shaver was then inserted into
    the knee, placed under suction, and staying right beneath the
    patella area and the very large open area of the hematoma, we
    were able to shave out the hematoma. We went back and forth
    multiple times, re-irrigating the knee, flushing it out
    aggressively, manipulating the knee and the soft tissues around
    it to free up as much clot as possible. These were taken out
    without much difficulty. We went back and forth and ended up
    running a couple of liters of antibiotic solution through the
    knee while simultaneously removing all the clot. When we flexed
    the knee up, we could get it to about 100 degrees. Some hematoma
    was evacuated from the subcutaneous tissue through the staple
    line. By rolling along the staple line, we were able to get this
    hematoma out as well. When all was said and done and multiply
    irrigated the knee with antibiotic solution, sucked out all the
    clot that was possible, the knee actually looked quite more
    normal. It would basically bend passively to about 100 degrees.
    Happy with this, the portal was closed with 3-0 nylon suture.
    Big bulky dressing was applied as was a little bit of a
    compressive ace bandage. A tourniquet was deflated. The patient
    was awakened and transferred to recovery room in stable
    condition.
    maybe 29871...

  3. Default
    I am not sure that I agree with 29871, as there is no infection (unless I totally missed it, which is possible, lol)

    You may end up having to go with the unlisted code 29999 and compare to open code 27301, or depending on the insurance carrier, use CPT code 27301 and in box 19 write "performed arthroscopically".

  4. Default
    Thanks for your help. The insurance is Medicare and no, you didnt miss anything there was no infection or concern of infection - Its a tough one. Thanks for both of your inputs and help!

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