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OCD Knee

L Posted Sun 17th of January, 2016 17:43:00 PM

How would I code this procedure:
DIAGNOSIS: Left knee osteochondral lesion measuring 15 x 15 cm.

PROCEDURE: Left knee scope with open reduction internal fixation of left knee osteochondral medial femoral condyle lesion and proximal tibia bone graft taken through a second incision.
Thanks.

SuperCoder Answered Mon 18th of January, 2016 12:07:05 PM

Team is working on the query. Will get back to you soon.

SuperCoder Answered Mon 18th of January, 2016 12:07:05 PM
Team is working on the query. Will get back to you soon.
SuperCoder Answered Tue 19th of January, 2016 06:27:51 AM

Hi, Please elaborate the scenario. Is the ORIF Knee open or Arthroscopic procedure?
As per CPT guidelines when the physician cannot complete the procedure through the arthroscope, and an open procedure is performed, list the open procedure first, code the arthroscope as diagnostic, and append modifier 51. Medicare and some other third-party payers do not allow a scope procedure when performed in conjunction with a related open procedure. Check with individual payers regarding their specific coding guidelines.

Thanks

SuperCoder Answered Tue 19th of January, 2016 06:27:51 AM
Team is working on the query. Will get back to you soon.
SuperCoder Answered Tue 19th of January, 2016 23:06:25 PM

Please see the above comment.

L Posted Sun 24th of January, 2016 19:25:08 PM

. His left knee was placed in an arthroscopic knee holder and was sterilely prepped and draped in the usual fashion. An inferolateral portal was established using a horizontal portal at the inferior pole of the patella adjacent to the patellar tendon. Blunt trochar was placed into the notch. Flow was established. Viewing the suprapatellar pouch, there were no noted osteochondral lesions. Bringing the scope down to the medial gutter, there was a recess of the cartilage on the lateral part of the medial femoral condyle where the defect resided. There was some bogginess using the probe, while probing the fragment, demonstrating that it was loose. There was no noted meniscal tear, lateral compartment was pristine. The ACL and PCL were intact. The plan was then to proceed with an open procedure. I extended my incision to approximately 5-6 cm in a longitudinal fashion incorporating my medial portal. Dissection was carried down through subcutaneous tissues, incising the capsule with a parapatellar approach. The defect was exposed. The 15-blade was used to define the defect and then an osteotome was used to pry it gently from the knee. There was a small amount of bony backing on the fragment. Next, I drilled into the bone using a 0.062 K-wire. A separate 1 cm incision was made along the medial part of the proximal tibia where a small amount of bone was harvested and packed into the defect on the femoral side. I then laid the cartilaginous piece into the defect and secured it with three 3.0 compression screws, which were countersunk beneath the level of the cartilage.

SuperCoder Answered Mon 25th of January, 2016 07:33:09 AM

Hi,

As per the procedure performed I think CPT code 27416 is the appropriate code. Sine, arthroscopy is converted to open, so we will code open procedure.

Thanks

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