Arthroscopic+Open Knee Procedure

Hey everyone!!!

My doctor seems to think that I can bill removal of the cyclops lesion with 29874. He also said (although it is not in the op note and will have to have it fixed) that he did a culture and biopsy. I only see 29881 for meniscectomy and 20680 for deep hardware removal. Does anybody see anything else? Can I bill for the culture and biopsy???

Thanks so much!!

POSTOPERATIVE DIAGNOSIS: Left knee lateral meniscal tearing with
cystic tibial lesion, painful hardware, plus removal of 1.5 cm cyclops
lesion.

PROCEDURE: Left knee arthroscopy, arthroscopic removal of 1.5 cm
cyclops lesion with arthroscopic lateral meniscectomy, arthroscopic
lateral chondroplasty, open removal of tibial screw with irrigation
and debridement of tibial cyst.

INDICATIONS: The patient is a 38-year-old status post ACL
reconstruction complaining of pain over the anterior aspect of his
tibia posteriorly and laterally and also pain. Risks and benefits of
surgery were discussed with the patient and he wished to proceed.

The patient was brought to the operating room, placed supine on the
operating room table. After induction of general anesthetic, his left
leg was examined. He was stable to varus valgus stress. He had a
negative Lachman, anterior and posterior drawer and negative pivot
shift. His left leg was prepped and draped in a standard surgical
fashion. Lateral portal was created. Examination of the joint showed
normal medial articular surfaces with normal meniscus. ACL graft was
intact. There was a 1.5 cm x 1.5 cm cyclops lesion with calcified
tissue within it, which was removed with a duckbill punch and a 3.5 mm
full-radius shaver arthroscopically. Lateral compartment had
significant chondromalacia and softening of the tibial plateau with
flaps of cartilage that were flipping superiorly. A Cloward was used
to feel articular bone deep to the cartilage. A duckbill punch and a
3.5 shaver were used to debride a radial tear of the posterior horn of
the lateral meniscus back to a stable rim. The tears were seen
laterally and anteriorly. The remnant of the tear had a horizontal
component to it superiorly and inferiorly not stable. Patellofemoral
joints had grade 2-3 changes essentially along the trochlea, grade 2
changes on the patella centrally. No loose bodies in the pouch or
gutter.

Attention was then directed to the tibial screw site where an incision
was made over the screw site. Yellow fluid was removed and sent for
culture and pathology with stat Gam stain. Sutures were removed from
the previous ACL site. Fragments of absorbed screw were seen. The
tunnel and cyst were curetted and debrided. There were no other signs
of infection.

After irrigation, the incision was closed with 3-0 PDS, 3-0 nylon. A
dry sterile dressing was applied. The patient tolerated the procedure
well and returned to recovery in stable condition.

Arthroscopic+Open Knee Procedure