ortho coding

Hi, how would I code a diagnostic arthroscopy, debridement, partial synovectomy and posterolateral meniscectomy? Chronic osteoarthritis, left knee complex tear right lateral meniscus, acute synovits involving all compartments?

Thank you for your help!

re: ortho coding

29881

re: ortho coding

Hi, this is what I used with dx 715.16, 717.40, 727.2

I was told it is incorrect.
Here is the op note, maybe I missed something??? Can you help??

Preoperative diagnosis

1. Chronic osteoarthritis, left knee with complex tear of the right lateral meniscus

Postoperative diagnosis

Same as above with the additional findings of acute synovitis involving all compartments.

Procedure

1. Diagnostic arthroscopy
2. Debridement
3. Partial synovectomy
4. Posterolateral meniscetomy
Description of procedure

Patient was transferred to the Operating Room. After adequate anesthesia was administered, the left lower extremity was prepped and draped in sterile orthopedic manner with the knee holder and tourniquet in place. At this point the leg was exsanguinated of blood and the tourniquet inflated to 300 mmHg pressure. Approximately 20 cc of normal appearing fluid was removed. The knee was then inflated with fluid, flexed to 90 degrees. Anterolateral portal was made and enlarged with a hemostat. Blunt tp trocar was inserted and directed to the suprapatellar pouch. A 30 degree scope was inserted. Orientation was obtained with the inflow cannula and was immediately noted to have some arthritic changes in the retropatellar surface, as well as acute synovitis in the suprapatellar pouch. The medial compartment was entered. There was some discoloration of the femoral condyle and tibial plateau and some degenerative changes in the tibial plateau. There was noted to be acute synovitis in all compartments. At this point, an additional anteromedial port was made and enlarged with a hemostat and utilizing a 40 full radius shaver. Partial fat pad resection was performed to allow better visualization and partial synovectomy in the intracondylar notch area and the fat pad region. Medial meniscus was visualized and probed in its entirety and found to be free of any tears. The lateral compartment was then entered. ACL and PCL were noted to be intact. It was also noted that there was significant arthritic changes with full thickness cartilage loss of both the femoral condyle and tibial plateau region and this was a complex tear of the posterior third of the lateral meniscus, basically from superior to anterior to the popliteal tendon, extending all the way back to the posterior horn. At this point utilizing the combination 40 full radius shaver, ArthoWand, straight and up biters, a partial posterior 1/3 lateral meniscetomy was performed and the edges were smoothed. Remaining edges were probed and found to be stable. At this point, the articular surface was debrided utilizing the 40 full radius shaver in high speed mode to smooth up any articular defects. After adequate debridement, attention was returned to the suprapatellar pouch, where partial synovectomy was performed in this area. At this point the knee was thoroughly irrigated. All instrumentation and fluid were removed from the knee and puncture wounds were closed with 4-0 Nylon and then Neosporin, Xeroform and bulky dressing were applied after the knee was injected with 5 cc of 0.25% Marcaine and 1 cc of Kenalog. Patient was then taken to the Recovery Room.

CPT® Code(s):

ICD-9 Code(s):


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re: ortho coding

29881 and 29875-59 since the sinovectomy done on the different compartment (Patellar region)

ICD: 717.43, 727.00, 715.96

re: ortho coding

Thank you so very much!