I wanted to get your opinion on this case. Should it be only 29880 or should a 29877 be coded also due to chondroplasty of patella? There has been some debate in our office as to correct coding. It is a commercial payer and I work at an ASC. Any suggestions would be appreciated!!
Left knee medial meniscal tear.
1. Left knee medial meniscal tear.
2. Lateral meniscal tear.
3. Grade II chondrosis of patella, medial femoral condyle, and lateral tibial plateau.
1. Left knee arthroscopy with partial medial and lateral meniscectomies.
2. Chondroplasty of the patella, medial femoral condyle, and lateral tibial plateau.
Sandie is a 60-year-old woman with a history of medial knee pain and mechanical symptoms and an MRI showing a medial meniscal tear. She has failed conservative treatment and was indicated for arthroscopic management.
Exam under anesthesia revealed a moderate effusion and full range of motion 2 quadrants of medial and lateral patellar glide, neural passive patellar tilt. Ligamentous exam was stable.
Arthroscopic examination of the suprapatellar pouch and medial and lateral gutters was unremarkable. Examination of the patella revealed some loose chondral flaps at the superior pole and the inferolateral pole, otherwise the articular surface was intact. Examination of the trochlea revealed no significant chondral lesion. Examination of the notch revealed the cruciate ligaments to be intact. Examination of the lateral compartment revealed a flap tear off the posterior horn of the lateral meniscus. There was some grade II fibrillation of the lateral tibial plateau. Examination of the medial compartment revealed a sudden increase in opening with resulting from a grade II MCL injury with just moderate valgus stress on the compartment. Following this, she had grade II valgus laxity with a good endpoint on valgus stress. Again, this occurred with only moderate valgus stress and it was felt to likely represent a reinjury to the MCL. There was just a partial tear and it was felt that it would probably heal up nicely with conservative treatment postoperatively. There was a complex degenerative tear of the posterior horn of the medial meniscus with several loose underside flaps of the meniscus. There was a small grade II-III chondral lesion of the medial femoral condyle just adjacent to the notch with some loose chondral flaps.
PROCEDURE IN DETAIL:
Following induction of general anesthesia, the left thigh tourniquet and thigh holder were applied. The right leg was placed in a well?leg holder. Under sterile conditions, the left knee was injected with 30 cc of 0.25% Marcaine with epinephrine in a standard fashion. The left lower extremity was then prepped and draped in the usual fashion.
Standard anterolateral and anteromedial portals with superolateral outflow were established and diagnostic arthroscopy was performed with the findings as above. The shaver was used to debride the posterior horn of the lateral meniscus as well as the fibrillated articular cartilage on lateral tibial plateau. Next, the basket and shaver were used to resect the unstable meniscal flaps from the posterior horn of the medial meniscus and the remaining meniscus was smooth with the shaver and then stable to probing. The shaver was also used to debride the chondral flap from the medial femoral condyle. Next, the shaver was used to debride the chondral flap from the patella.
The arthroscope was withdrawn. The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the joint. A sterile dressing was applied followed by a TED hose and a knee immobilizer. The patient was awakened and extubated in the operating room and transferred to the recovery room in stable condition.
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