AHA Coding Clinic® for HCPCS - 2023 Issue 3; Ask the Editor
Arthroscopic ACL repair with open ligament repair
A patient presented with left knee instability, anterior cruciate ligament (ACL) and lateral meniscus tears. After induction of anesthesia, a 4 cm incision was made from the superior pole of the patella into the quadriceps. Full-thickness flaps were created down to the paratenon. The central third of the quadriceps tendon was harvested. A 9 x 70 mm soft tissue portion of the graft was cut, taken to the back table and sized to a 9 mm sizer. Tight ropes were attached to the femoral button along with a fibertape for internal brace. Arthroscopy portals were established, and the trocar was inserted into the patellofemoral joint. Diagnostic arthroscopy revealed a complete tear of the ACL and a tear of the lateral meniscus. The tear edges were brought together to repair the tear. The femoral and tibial attachments of the ACL were debrided, and a reamer was used to drill a 20 mm bone socket into the lateral femoral condyle wall. The anatomic tibial tunnel was drilled and the graft was passed through the medial portal into the femoral tunnel and through the tibial tunnel. The graft on the femoral side was repaired using a secured tightrope on the lateral wall and shuttled the graft into the femoral socket. The internal brace was secured along the tibia using a 4.75 SwiveLock anchor. The ACL tibial fixation sutures were tied down with the knee in slight flexion. The camera was placed back into the knee. The graft had good tension and the arthroscopic debris was removed from the knee. Next, full-thickness flaps were developed down to the level of the iliotibial band (IT band). A small window was made in the IT band to locate the anatomic attachments of the popliteus tendon as well as the lateral collateral ligament (LCL). The anatomic location of the popliteofibular ligament posterior on the fibula was torn in addition to the LCL and popliteus tendon. On the back table, semitendinosus allograft was thawed out, sized to a 4.5 mm sizer, and whipstitched on the proximal and distal ends with #2 FiberWire.Several anatomic tunnels were created for the popliteus tendon, lateral collateral ligament, and popliteal fibular ligament reconstruction with the semitendinosus allograft. Intraarticular and extraarticular popliteus tendon reconstruction was performed.What are the appropriate codes for the procedures performed? When arthroscopic and open techniques are both performed during the same surgical encounter, can the CPT codes be reported for both techniques? ...
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