I am considering coding this as 27486 & C1776 for billing the ASC.
Please see the op note and your rendered opinion is greatly needed and appreciated.
Would you feel excision of the patellar fragment (27331) is inclusive to the knee revision? Per my coding software, it does show as a bundled procedure.
Postoperative Diagnosis: Avascular necrosis, left patella
Procedure Performed:
1. Revision left total knee arthroplasty, one component.
2. Excision of patellar fragment.
Indications: The patient is a 65-year-old male who had patellar avascular necrosis and flattening with impingement of the patellar fragment on the prosthesis. The patient failed conservative treatment and wished to undergo surgical intervention. The patient understood all risks, benefits, and alternatives and wished to proceed. Consent was obtained.
Description of Procedure: The patient was then identified in the preoperative holding area where the correct limb was marked at this time. The patient was then transported back to the operative suite where he was placed on the table in the supine position. Spinal anesthesia was then administered. The left lower extremity was then prepped and draped in sterile fashion. A time-out was then performed. Using a #10 blade scalpel, an incision was made in the skin and previous scar revised. Medial parapatellar arthrotomy was then made. A medial exposure was made and care was taken not to take down the MCL. A complete synovectomy was then performed of the knee. We then exposed the knee and removed the polyethylene insert. We then exposed the patella. Once this was done, we found a patellar fragment, which was impinging and deflection on the lateral side of the femoral component. This was exposed and then using a rongeur, we excised the fragment. We then placed our trial spacer and we did not have any more impingement and the patella was tracking well. We then placed our final polyethylene spacer with centering screw with counter torque and tensioning to 95 foot-pounds of torque. We then cycled the knee, made sure we had good full range of motion without any impingement, which it did. We then irrigated for 3 minutes with a dilute Betadine lavage followed by Pulsavac lavage. Our Ranawat cocktail was injected throughout the knee. Then, 2 g of vancomycin powder was placed in the knee wound. We then closed our arthrotomy using #1 Vicryl in an interrupted fashion followed by #2 Quill in a running fashion. The subcutaneous tissue was approximated using 2-0 Vicryl in an interrupted fashion. The skin was approximated using 2-0 Quill in a running fashion. The wound was then washed, Dermabond and a sterile dressing applied. The patient was then awakened and transported to PACU in stable condition. All sponge, needle, and instrument counts were correct following the procedure.
Please see the op note and your rendered opinion is greatly needed and appreciated.
Would you feel excision of the patellar fragment (27331) is inclusive to the knee revision? Per my coding software, it does show as a bundled procedure.
Postoperative Diagnosis: Avascular necrosis, left patella
Procedure Performed:
1. Revision left total knee arthroplasty, one component.
2. Excision of patellar fragment.
Indications: The patient is a 65-year-old male who had patellar avascular necrosis and flattening with impingement of the patellar fragment on the prosthesis. The patient failed conservative treatment and wished to undergo surgical intervention. The patient understood all risks, benefits, and alternatives and wished to proceed. Consent was obtained.
Description of Procedure: The patient was then identified in the preoperative holding area where the correct limb was marked at this time. The patient was then transported back to the operative suite where he was placed on the table in the supine position. Spinal anesthesia was then administered. The left lower extremity was then prepped and draped in sterile fashion. A time-out was then performed. Using a #10 blade scalpel, an incision was made in the skin and previous scar revised. Medial parapatellar arthrotomy was then made. A medial exposure was made and care was taken not to take down the MCL. A complete synovectomy was then performed of the knee. We then exposed the knee and removed the polyethylene insert. We then exposed the patella. Once this was done, we found a patellar fragment, which was impinging and deflection on the lateral side of the femoral component. This was exposed and then using a rongeur, we excised the fragment. We then placed our trial spacer and we did not have any more impingement and the patella was tracking well. We then placed our final polyethylene spacer with centering screw with counter torque and tensioning to 95 foot-pounds of torque. We then cycled the knee, made sure we had good full range of motion without any impingement, which it did. We then irrigated for 3 minutes with a dilute Betadine lavage followed by Pulsavac lavage. Our Ranawat cocktail was injected throughout the knee. Then, 2 g of vancomycin powder was placed in the knee wound. We then closed our arthrotomy using #1 Vicryl in an interrupted fashion followed by #2 Quill in a running fashion. The subcutaneous tissue was approximated using 2-0 Vicryl in an interrupted fashion. The skin was approximated using 2-0 Quill in a running fashion. The wound was then washed, Dermabond and a sterile dressing applied. The patient was then awakened and transported to PACU in stable condition. All sponge, needle, and instrument counts were correct following the procedure.