A patient with failed right quadriceps mechanism of total knee is admitted for surgery. The surgeon identified his operation as “right knee quadriceps reconstruction with new tibial polyethylene.” Based on the title of the operative report, it appears that a revision of knee replacement was performed. However, based on the description of the surgery within the operative report it appears that the surgeon replaced the tendon and kneecap with a donor tendon and kneecap. Therefore, would this be coded as a revision of a total knee replacement or as a tendon transplant? What is the appropriate procedure code assignment for this case?
Assign codes 78.06, Bone graft, patella, and 83.81, Tendon graft, for the tendon and bone grafts used to reconstruct the quadriceps. “Quadriceps mechanism” is the orthopedic name for the natural quadriceps tendon with the patella embedded in it. Failed quadriceps mechanism is an uncommon complication of knee replacement surgery in which the quadriceps tendon is ripped off the tibial tubercle.
Although the surgeon described the surgery as quadriceps reconstruction with replacement of tibial polyethylene, the operative report does not support this. There is no description of replacement or revision of knee joint, or device name or model number. According to the operative report, the surgeon replaced the tendon and kneecap with a donor tendon and kneecap.