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Old 04-09-2010, 09:32 AM
skorkfranks skorkfranks is offline
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Default 27488 vs 11983???

Good morning coders,

I have a doc who did a removal of a knee prostesthis (CPT 27488) with the insertion of a cement spacer (11981) on 2/26/10. On 4/2/10 he did an I&D with a resection and then replacement of antibiotic spacer as well as intramedullary dowels. He is using CPT 27488, but I'm wondering if he should be using 11983 and an I&D code. ICD-9 is 996.66. I have attached the OP note. Thanks for any input!!!!!

PREOPERATIVE DIAGNOSES: Joint sepsis status post antibiotic cement spacer placement of the right knee. Indication is to treat infection.

POSTOPERATIVE DIAGNOSES: Joint sepsis status post antibiotic cement spacer placement of the right knee. Indication is to treat infection.

OPERATION: Irrigation and debridement. Resection and then replacement of antibiotic cement spacer as well as intramedullary dowels.

SKIN PREP: ChloraPrep.

PROCEDURE IN DETAIL: Following discussion of risks, benefits, alternative treatment, surgical, and nonsurgical, the patient consented to the surgery. Prior to incision, the patient had been receiving antibiotics preoperatively and continued on that regimen. Through his midline incision, the knee was approached via standard median parapatellar approach. There was gross purulence within the joint. Also tissue and fluid cultures were sent for specimen. Mediolateral gutters were cleared. Medial release was performed. Previously applied static spacer in the joint was removed. The knee was gently flexed up and the patella was tucked to its lateral gutter. The previous antibiotic dowels were removed. Using reamers as well as backbiters and hooks, the canal was copiously debrided. There was visually evident chunks of cement remaining. Using a burr the proximal metaphyseal tibia was burred in order to provide clean surfaces. Using a total 12 liters of pulse lavage, the canal was copiously irrigated as well as the joint space. Back surface of patella was curetted and burr to healthy bleeding bone. Using antibiotic cement, one batch on the femur, and one batch on the tibia, vancomycin dowels were again fabricated. I inserted antegrade and retrograde through the tibia and the femur respectively. Then using two batches cement with 6 g of vancomycin in addition to gentamicin, the static antibiotic spacer was fabricated for the tibiofemoral space. Tourniquet was let down. Hemostasis was obtained. The extensor mechanism was closed using #0 PDS over single drain. The remainder of the skin was closed with #0 PDS, #2-0 PDS, #and 2-0 nylons. Sterile compressive dressing was applied. The patient was placed in a well-padded and well-molded long leg posterior splint and the knee immobilizer. The patient was transferred to recovery room in stable condition.
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