Chapter 5 Case Studies (Even-Numbered Questions)
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ICD-10-PCS An Applied Approach
Lynn Kuehn
Therese K. Jorwic
Chapter 5
Case Studies
2. Operative Report PREOPERATIVE DIAGNOSIS: Right knee, failed UKA
POSTOPERATIVE DIAGNOSIS: Right knee, failed UKA
OPERATION PERFORMED: Right partial knee revision to total knee replacement using MAKOplasty endoscopic robotic assistance
IMPLANTS: Stryker Size #6 femur, #6 tibia, 13 mm poly, S 36mm patella
INDICATIONS FOR SURGERY:
Patient is 62 years old and has severe right knee pain with a history of medial compartment unicondylar arthroplasty 6 years ago. Radiographically, there is evidence of loosening of the components. The risks, benefits, and rationale were explained to the best of our ability.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room, placed under general laryngeal
mask anesthesia, after getting adductor canal block preoperatively. My initials were clearly visible on the operative side. Timeout was done in the usual fashion. The right knee was sterilely prepped and draped in the usual fashion.
Incision was marked and ioban was placed over the knee. We proceeded
to open up the knee, taking down the skin and subcutaneous with a knife. The Bovie was used for hemostasis. We then put the pins in the femur and the tibia and registered the hip and the knee and ankle per the MAKO protocol. Specimen was sent to pathology to confirm no evidence of infection. We proceeded to do fine registration of the joint balancing portion of the procedure. Some osteophytes were removed. Once the joint balance was done, we were very pleased with the overall alignment and balance of the components. We adjusted the plan for implant placement and then proceeded to cut the femur in concordance with the plan. Osteotomes were used to loosen the femoral components from the initial cut. Then followed by
the tibial cut, sparing the PCL and again using the osteotome to remove the implant. Bone pieces were removed from the joint and then placed the trial components, checked the joint balance to determine appropriate poly thickness. At that point, we made our patella cut flush, chose the appropriate
size, and drilled the lugs. After that, we cemented in the final tibia and
locked the final poly in place before cementing in the femur and patella components without difficulty. Drain was placed in the knee joint. The excess
cement was meticulously removed. Removed the pins and markers from the tibia and femur.
A postoperative analgesic cocktail was injected into the periosteum and capsule of the knee. The patient was sutured with 1 Vicryl in the retinaculum,
2-0 Vicryl subcutaneous and 3-0 monocryl in a running subcuticular stitch, covered in leukostrips. Mepilex dressing and Ace bandage. Patient was placed in a knee immobilizer with a polarcare system. The patient was brought awake and in stable condition to the recovery room.
Root Operations: Removal and Replacement
Body System: Lower Joints
ICD-10-PCS Codes: 0SPC0LZ and 0SRC0J9
Explanation: The femur, tibia, and patella were excised, and the previous implants (from the previous partial/unicondylar replacement 6 years ago) were removed before inserting and cementing the new implants. According to the book, any subsequent replacement procedures would require separate
codes for the removal of the replaced body part and the additional replacement procedure. The operation performed also indicates they initially intended to perform a right partial knee revision but they adjusted their plan for implant placement/total knee replacement instead so the removal of the old implant and the replacement with a new implant are both coded.
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