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Knee Revision ?

  1. Default Knee Revision ?
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    I believe I would code this procedure 27486 - 52. Pretty new to Orthopedics and I just wanted to make sure I have the Polyethylene exchanges/removal correct as my docotor is pretty confused about this surgery. The arthrotomy, synovectomye and bridement would be included? Any responses or advice it much appriciated!


    POSTOPERATIVE DIAGNOSIS:
    Superficial and deep infection, left total knee.

    OPERATIONS PERFORMED:
    Left knee arthrotomy, extensive irrigation and debridement,
    complete synovectomy, removal of patellar polyethylene, and
    polyethylene bearing exchange.

    An incision was then made over the concerning area
    anteriorly in line with her previous knee incision. Upon
    entering this area, there was a subcutaneous cavity of
    granulomatous type tissue, bloody areas of fat necrosis, and
    hematoma. We placed the Yankauer sucker tip into the void and
    probed superiorly. We were able to find a defect in the extensor
    mechanism proximally at the site of her previous attempted
    patellar tendon repair that communicated with the knee joint. We
    therefore extended our incision and made a medial arthrotomy. We
    elevated off the medial tibia around the deep MCL. We performed
    a complete synovectomy and debridement of the knee with cautery
    and sharp dissection. This involved the suprapatellar pouch,
    medial and lateral gutters, posterior aspect of the knee as best
    we could access. The cultures were obtained during this process
    prior to any irrigation. Stat Gram stain was negative for any
    bacteria. We removed the tibial polyethylene and again removed
    the patellar polyethylene. We sort of made a freshening cut on
    the patella but did not resurface it. We continued to debride
    any suspicious looking tissues both deep as well as in the
    superficial subcutaneous pocket that we had entered initially.
    Any suture from her previous attempted patellar tendon repair
    was removed as well. We ended up irrigating the entire knee with
    9 L of bacitracin and saline, performing an extensive
    debridement. We placed a size 10 posterior stabilized Zimmer
    NexGen poly for 3 tibia and an E femur. Decision was made to
    leave the implants in place. We did not yet have any specific
    bacteria that had grown on culture. The patient is very obese
    and we felt it was worth an attempt at salvage.

  2. #2
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    Quote Originally Posted by Sara82 View Post
    I believe I would code this procedure 27486 - 52. Pretty new to Orthopedics and I just wanted to make sure I have the Polyethylene exchanges/removal correct as my docotor is pretty confused about this surgery. The arthrotomy, synovectomye and bridement would be included? Any responses or advice it much appriciated!


    POSTOPERATIVE DIAGNOSIS:
    Superficial and deep infection, left total knee.

    OPERATIONS PERFORMED:
    Left knee arthrotomy, extensive irrigation and debridement,
    complete synovectomy, removal of patellar polyethylene, and
    polyethylene bearing exchange.

    An incision was then made over the concerning area
    anteriorly in line with her previous knee incision. Upon
    entering this area, there was a subcutaneous cavity of
    granulomatous type tissue, bloody areas of fat necrosis, and
    hematoma. We placed the Yankauer sucker tip into the void and
    probed superiorly. We were able to find a defect in the extensor
    mechanism proximally at the site of her previous attempted
    patellar tendon repair that communicated with the knee joint. We
    therefore extended our incision and made a medial arthrotomy. We
    elevated off the medial tibia around the deep MCL. We performed
    a complete synovectomy and debridement of the knee with cautery
    and sharp dissection. This involved the suprapatellar pouch,
    medial and lateral gutters, posterior aspect of the knee as best
    we could access. The cultures were obtained during this process
    prior to any irrigation. Stat Gram stain was negative for any
    bacteria. We removed the tibial polyethylene and again removed
    the patellar polyethylene. We sort of made a freshening cut on
    the patella but did not resurface it. We continued to debride
    any suspicious looking tissues both deep as well as in the
    superficial subcutaneous pocket that we had entered initially.
    Any suture from her previous attempted patellar tendon repair
    was removed as well. We ended up irrigating the entire knee with
    9 L of bacitracin and saline, performing an extensive
    debridement. We placed a size 10 posterior stabilized Zimmer
    NexGen poly for 3 tibia and an E femur. Decision was made to
    leave the implants in place. We did not yet have any specific
    bacteria that had grown on culture. The patient is very obese
    and we felt it was worth an attempt at salvage.
    Yes..27486-52 is the correct code..but I always offer my doc the option of NOT adding a 52 modifier if he feels he did more work that just a poly exchange as the 52 mod is not always set in stone..

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