Posted on 20. Sep, 2009 by in Hot Coding Topics
Can you tackle an op note like this one we got our hands on? Relax. We help you break it down into 3 steps.
Although you may be accustomed to TKR op notes, an unusual case might send you into a panic. Take a deep breath, and we’ll have you breezing through the challenges that atypical TKR op notes present, like coding for a necrotic bone graft from a prior fixation.
First, Read the Op Note
Review the op report and code the procedure on your own. Then check out our expert advice below.
Preoperative diagnosis: Status post severe bicondylar proximal tibia fracture, and post open reduction internal fixation with bone grafting (failed).
Procedure overview: The surgeon scheduled a patient for hardware removal (from a tibia fracture), as well as a total knee replacement. When he opened the patient, he found it necessary to perform major deep hardware removal, tibial tubercle reconstruction, trabecular metal coil insertion, wedge medial tibial base plate, and long stem tibial component (total knee replacement).
The pertinent details of the op report follow: After I opened the patient, I noted an obvious nonunion of the tibial tubercle. I removed the tibial tubercle wires and removed the plates and found that the massive amount of bone grafts that we had used intraoperatively had not consolidated and there was a tremendous amount of necrotic bone. I ununited the medial tibial plateau and discarded the large (3-cm) piece.
I used a trabecular bone proximal tibial reinforcer and shaped the inner tibia, removing some of the remaining cancellous bone from the proximal tibia to incorporate the trabecular cone into the proximal tibia.
We placed a rod up through the femur, inserted the distal femoral cutting block jig, cut the distal femur, and measured the femur to a size F....
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