lundi 22 septembre 2014

Hip arthroscopy Need Help

I hope someone can help not sure of how to bill these procedures.

arthroscopic procedure not sure how to bill this, and help or suggestions will be appreicated.


Here is the op-note in short.


RIGHT HIP DIAGNOSTIC ARTHROSCOPY, TROCHANTERIC BURSECTOMY, ABDUCTOR TENDON

REPAIR AND ILIOTIBIAL BAND LENGTHENING: With the hip not in traction, using

fluoroscopic imaging as a guide, an anterolateral portal was established under

guidewire technique. The trochanteric space was entered. There was moderate

bursitis and inflammation in the trochanteric space. A mid anterior portal

was established under direct visualization using a guidewire technique. Using

an arthroscopic shaver and a radiofrequency ablation device, an extensive

bursectomy was performed all the way proximally, distally, posteriorly and

anteriorly. At this point, once cleaning the entire bursa distal to the

gluteus maximus tendon, I could visualize the entire trochanteric space.

There was bruising and ecchymosis of the abductor tendons attached to the

greater trochanter. At the first glance, the tendons appeared to be intact,

but probing the tendons, they had no attachments beneath. There seemed to be

a high-grade undersurface tear. Using a Beaver blade, a longitudinal incision

in the tendons was performed. There was a clear tear underneath the abductor

tendons noted that had extended all the way proximally and distally. Using an

arthroscopic shaver, the abductor tendons were debrided and the footprint of

the tendons was debrided such that a good bleeding bony bed was identified.

The tendon was probed and _____ was able to pull and be brought over to the

footprint well. A third arthroscopic portal was then established, just

distally, a distal anterolateral portal was established. A percutaneous

portal was established and an anchor was placed in the center of the

footprint. A 5.5 mm _____ anchor was used. An excellent

purchase was obtained. We then used a 90-degree SutureLasso to pass sutures

through the abductor tendons proximally and distally. An excellent repair was

obtained. The sutures were tied with a combination of sliding and half hitch

sutures. Excellent repair of the tendon was noted. Once the tendon was

repaired that tendon was probed and was firmly reattached back to the

footprint. Copious irrigation was performed. Having performed the bursectomy

and abductor tendon repair, we focused our attention on the IT band. I did

not want to make a large window through the IT band and therefore just did a

gentle release of the gluteus maximus attachment at the IT band, thus creating

less tension and affect the lengthening of the IT band. Copious irrigation

was once again performed. All the bursa had been excised as extensively as

possible. The abductor tendon had been repaired and the IT band tension was

decreased. The patient had tolerated the procedure well. All the

arthroscopic equipment was removed. The 3 arthroscopy portals were closed

with 2-0 Vicryl in a deep fashion, 3-0 Monocryl in a subcuticular fashion and

Mastisol, Steri-Strips, Xeroform, and dry sterile dressings were applied. The

patient was awakened, taken to recovery room. She was wiggling her toes, had

brisk capillary refill.


Would it be appropriate to bill 29863 for the bursectomy and then 29999 for the ITband lengthening????






Hip arthroscopy Need Help

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