Cheryl Posted Fri 22nd of May, 2015 09:56:34 AM
I coded the total knee with 81.54. Do I need to code anything else such as tendon repair, etc? What would the codes be?
PROCEDURE: Left total knee arthroplasty with lipomatous tissue removal , especially at the patella and inferior with skin excision thru discoloration locale inferiomedial. Lateral capsular repair, inferior patellar tendon repair.
We were able to incise in the midline for 5 inches, separated the soft tissues, slid her patella laterally as we really did not have to utilize the scissors whatsoever to strip some of the subcutaneous tissue from the incisional locale s it was attached in paltry fashion. We would find that no skin contact with subcutaneous tissue was evident through the discolored region inferomedially. At this juncture, however, we were able to approach the femur. We saw that it had fully formed in with bone at the superior trochlear extent and the ridge of bone was obviating any groove. We were able to 6-degree valgus step cut the femur size to a 70. We then were able to flat cut the tibia size to a 67 with the Biomet system and proceeded with removal of the lateral meniscus. The medial meniscus was very paltry and almost nonexistent. We then were able to score the tibia and femur. With the trial, she did not extend fully but only lacked about 5 degrees and any hyperextension was a problem passively ahead of time, so we were pleased with this plus her tissue is very lax, loose and flimsy if you will. We found good stability. We then proceeded with the coring of the patella to a 28. We then were able to proceed with a removal of one of the largest spurs and osteophytes we have seen. It was on the patellar on the lateral extent, and then we were able to irrigate throughout. We followed with antibiotic impregnated irrigation with a bulb syringe, and then we were able to cement the 67 tibia into position with a +10 anterior stabilized interface, E polyethylene. We followed with the femoral press-fit of a 70 and then we were able to add the patellar button. We used cement for this both on the patella and the native side . We followed tem with closure. We were able to then utilize #1 Ethibond for the superomedial repair of the retinacular locale. We added a #5 at the central portion. The lateral capsular tear was at the joint line and there was fraying of the tissues so that we could overlap and take a sector of capsule from the superior extent and extend it into the inferior aspect more posteriorly. We utilized a #5 Ethibond with a Mason-Allen type of suture for this and then add some #1 Ethibond sutures to close the gap. We left open a lateral retinacular type of incision so that there would not be too much pressure through this locale, and then we used a figure-of- twelve in essence with a #1 Ethibond for the intrapatellar tendon as it was a split system that would split even more significantly when her knee was extended. We were very impressed with the lack of resilience of her tissue, and then the region of discoloration at the inferomedial extent of her knee was where the skin was not attached to any subcutaneous tissue. This was there this would split even with any degree of retraction. I excised some of the central portion of the skin leaving just a 1 cm rim on the proximal side which was then still voided of subcutaneous tissue attachment. We had removed copious amounts of adiposity throughout her knee just largely with hand pressure. Then they closed it.
SuperCoder Answered Fri 22nd of May, 2015 23:43:24 PM
AAE does not provide coding for operative reports and chart notes.
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