One year ago, a patient underwent a resection arthroplasty of the left knee. During that admission, antibiotic spacers were inserted with anticipation of later reimplantation of a new joint prosthesis. Unfortunately, the patient’s poor health status precluded additional surgery. The patient now presents with infected left knee, and was taken to surgery for removal of the existing cement spacers. At surgery, an extensive excisional debridement was performed, involving skin, muscle, and bone (proximal tibia and distal femur). The previously placed cement implants were removed, and a new antibiotic loaded cement spacer was placed. A cannulated reamer was used to ream out the proximal tibia and distal femur of purulent material. Widespread excisional debridement of all necrotic and infected sites was accomplished using sharp dissection. Is it appropriate to assign codes for the excisional debridement in addition to the replacement of the cement spacer?
Assign code 77.65, Local excision of lesion or tissue of bone, femur, and code 77.67, Local excision of lesion or tissue of bone, tibia and fibula, for the excisional debridements of the proximal tibia and distal femur, in addition to code 84.56, Insertion or replacement of (cement) spacer. In this case, the principal intent of the procedure was excisional debridement. Because of the infection and deep pockets of pus, extensive debridement including reaming of the canal was carried out. This degree of debridement is usually not required as simple preparation to replace a spacer.