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Thread: Please Help-Ortho Operative Note

  1. #1

    Post Please Help-Ortho Operative Note

    AAPC: Back to School
    Even the physician was stuck on what to bill for this procedure. The hospital suggested billing 29867 and G0289-he stated this was incorrect. He stated bill Diagnostic Arthroscopy, and an additional code for osteochondral allograft, stating he did a bone graft of the tibia, it was an open procedure and allograft was used-but he did not know what code supports this. I AM COMPLETELY CONFUSED! Please help!! -April

    The patient had range of motion 0 to 130 degrees stable to varus valgus stress at 0 and 30 degrees. He had a grade 2B Lachman, grade 1A posterior drawer, positive pivot shift on the right knee. At this point in time, the right lower extremity had a tourniquet placed proximally and prepped and draped in a sterile manner. Diagnostic arthroscopy was to be performed. The knee was injected with a total of 20 cc of 0.25% Marcaine to include the anterior, medial and lateral portals. The anterolateral portal was made. The patient had no loose bodies. She had grade II-III chondromalacia at the medial patella facet. No loose bodies of the medial portal was established. The medial meniscus and lateral meniscus were probed and found to be intact. The ACL was found to be loose, however, it was not
    torn. At this point in time, the ACL was debrided back to the lateral femoral wall and the
    remaining ACL was removed from the intra-articular port ion of the knee. Once this was done, a tourniquet was inflated to 300 mmHg. An incision was made over the prior incision on the tibia. Dissection continued down to the tibial screw which was found and removed. The tibial tunnels were removed of graft. Viewing the tibial tunnels with an arthroscope had showed that there had been a divergent tibial screw. The tibial tunnels were cleaned of all debris. Due to the divergent nature of this and the amount of bone loss, it was determined to bone graft the area. A 30 cc mixture of bone chips with DBM were mixed together. This was then packed into the bony defect in the tibia. A key osteotome was placed interarticularly blocking any bone graft to get to the joint. After the bone graft was packed, the joint was viewed and it showed no bone graft in the joint. Once this was done, the tourniquet was let down. There was no significant bleeding. The deep tissue was closed with 0-Vicryl sutures. The subcutaneous tissue was closed with 2-0 Vicryl
    suture. Skin was closed with 3-0 nylon suture. 20 cc of 0.25% Marcaine plain were injected into the incision sites. The patient had a dressing of Xeroform, 4 x 4, ABD, Webril, and an ace bandage placed. She was then placed in her brace locked in extension. The patient had 2+ dorsalis pedis pulse after the surgery. The patient went to recovery in stable condition.

  2. #2


    you can bill 27415 or 27416. However, please be aware that Medicare does NOT cover these procedures and if the pt has DSHS and no preauthorization, they will not cover either. Hope this points you in the right direction, anyway.

  3. #3


    I really appreciate your reply. Thanks

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