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open primary repair of full-thickness chondral defect of the medial trochlea

Pia Posted Thu 25th of June, 2020 17:09:19 PM
what cpt code would you compare the above procedure, as there is no code for "open primary repair of full-thickness chondral defect of the medial trochlea" here's op notes........... He was in the supine position. Examination of the left knee demonstrated 2+ effusion. Neutral to slight varus alignment. Range of motion passively from 0 to 135 degrees of flexion. Stable knee to ligamentous exam. Leg was placed in a leg holder. The left lower extremity was prepped and draped in usual sterile fashion. Timeout procedure was performed. The knee was injected with local anesthetic. Standard anteromedial anterolateral portal sites were pre-injected. These were then established with an 11 blade. Arthroscope was inserted through the anterolateral portal. Standard diagnostic arthroscopy was performed. This demonstrated intact chondral surface of the patella. Full-thickness flap measuring approximately 2 cm in length by 15 mm in width was noted with a proximal based intact hinge. There was partial thickness injury to the flap but largely intact. Medial compartment demonstrated intact chondral surfaces and meniscus as did the lateral compartment. Cruciate ligaments were intact. Decision was made to proceed with arthrotomy to further assess for suitability for primary repair. Arthroscope was removed from the knee. A medial parapatellar arthrotomy incision was marked out connecting with the anteromedial portal. This was taken up to the superior pole of the patella. Local acetic was injected subcutaneously. Skin was incised with a 15 blade. Medial parapatellar arthrotomy was performed up to the level of the superomedial border of the patella. This allowed adequate mobilization to view the trochlear lesion. There was intact subchondral bone without bleeding response beneath the flap. The flap was elevated on it changed. Meticulous drying was performed of the subchondral bone. Fibrin glue was then brought to the field and placed on the subchondral plate. The flap was then reduced and the seems of the cartilage were then further sealed with fibrin glue. This was held in place with a gloved finger until dry. Gentle irrigation was performed. This demonstrated excellent reduction and stability of the chondral flap. Final photographs of this were taken. Irrigation was performed. The arthrotomy was then closed with #1 Ortho cord suture. Local anesthetic was then injected in the subcutaneous plane. The skin was then closed with buried interrupted 3-0 Vicryl suture followed by 4-0 running subcuticular Monocryl and Steri-Strips. Thank you!
SuperCoder Answered Fri 26th of June, 2020 09:18:22 AM

Hi Pia,

Thank you for your question.

The above procedure will be compared to CPT 27415, as medial parapatellar arthrotomy incision was made to correct the trochlear lesion and places flap to repair an osteochondral defect.

Feel free to ask for any further query.

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