Sample Coded report for Knee Arthroplasty CPT code

Pre-op Diagnosis: Primary osteoarthritis of left knee [M17.12]

Post-op Diagnosis: Same as Pre-op

Procedure(s):  Left – TOTAL KNEE REPLACEMENT ROBOTIC ASSISTED – Wound Class: Clean

Proc. Description(s) & CPT Code(s): TOTAL KNEE REPLACEMENT ROBOTIC ASSISTED: 

Stryker components:  Size 2 cemented tibia, size 2 Press-Fit femur, size 9 mm posterior cruciate retaining tibial polyethylene insert.  Patella not resurfaced  Anesthesia: General

Complications:  None

Findings:  The patient is a 67-year-old female with longstanding osteoarthritis of the left knee with bone-on-bone changes on x-rays unresponsive to nonoperative measures.  She desired a total knee arthroplasty.  She has a history of a contralateral right total knee replacement L snare was not quite satisfied.  We elected to set her up with a robotically assisted total knee arthroplasty.  Its risks benefits and limitations were discussed preoperatively and appeared to be very well understood.

Technique:  After a block by anesthesia, the patient was brought to the operating room.  The left lower extremity was prepped and draped sterilely below an upper thigh tourniquet.  Test dose of Ancef was given given her stated allergy to penicillin.  There was no adverse reaction whatsoever.  Vancomycin and Ancef were given for IV prophylaxis.  IV TXA was also administered.  After sterile prepping and draping and exsanguination, the tourniquet was inflated to 350 mm Hg.  A vertical incision was made just medial to the midline centered over the patella dissection was carried through the skin and subcutaneous tissues.  A medial parapatellar approach to the knee joint was utilized the patella was flipped laterally.  Soft tissue contractures were released the ACL was removed the PCL was left intact the medial and lateral meniscal remnants were removed.  Arthritic changes along the undersurface of the patella were mild.  Severe erosive changes were seen predominantly along the medial compartment.  Given the small size of the patella it was elected to not resurface it.  Pins were placed in the distal femur and proximal tibia per protocol for the robotic system.  The center of femoral head rotation was calculated and bony landmarks were registered.  This revealed that preoperative malalignment was slight and she had a moderate flexion contracture of 5°.  There was varus instability.  Minor adjustments to implant position and distal femoral and proximal tibia cuts were made to tighten up the loose knee joint and to balance flexion and extension gaps very well.  The robot was brought into the field locked in place distal femoral and proximal tibial cuts were made.  Optimal coverage of the femur was established with a size 2 femur with the tibia with the size 2 as well.  Given her age it was elected to cement the tibia but go with the Press-Fit femur given the bone quality was decent.  Bony surfaces were prepared antibiotic irrigation was used to irrigate it thoroughly.  Cement mixed in the vacuum Tanner was placed on the tibial side the back surface of the tibial component and the tibia itself it was impacted into position excess cement was trimmed away while soft with a Freer elevator.  The Press-Fit femur was then impacted onto the femur obtaining an excellent Press-Fit.  The 9 mm insert was locked into the tibial tray overall stability and range of motion were excellent.  Alignment was excellent.  There was a bit of tightness of the lateral retinaculum it was elected to perform a limited lateral retinacular release in a mesh pattern with the Bovie.  Patella tracking was excellent thereafter.  Irrigation was used throughout the case and prior to closure closure was accomplished by read reapproximating the retinaculum and repairing it with multiple interrupted 1. Vicryl sutures and a running 2. Quill suture.  Intraoperative range of motion was approximately 0 extension to 125 of flexion.  The subcutaneous layers were closed with interrupted 1. And 2 0 Vicryl and skin staples were used to close the skin.  A sterile occlusive Aquacel dressing was applied a light wrap and ice machine device were applied.  The patient tolerated the procedure well and was transferred to the PACU in stable condition

Disposition: awakened from anesthesia, extubated and taken to the recovery room in a stable condition, having suffered no apparent untoward event.

CPT code 27447 – LT Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)

ICD-10 code: M17.12