Intra-articular lysis of adhesions
Does anyone know the CPT code for Open Lysis of Intra-articular knee adhesions. I included the Op note below. Any help/direction much appreciated. Thank you Jody
His previous midline anterior incision was made, followed by a medial parapatellar arthrotomy. Subcutaneous flaps were performed to avoid adhesions between the subcutaneous and fascial layers. The gutters were then cleared of adhesions as well. Thickening of the capsule was excised sharply. This tissue was sent for culture. Scarring of the fat pad was excised sharply as well.
His previous polyethylene was removed. It did not have significant wear. Soft tissue was released posteriorly with a curved osteotome to strip the capsule from the posterior femur. In addition, curved osteotome was used to strip the capsule and PCL from the posterior tibia. Formal lateral retinacular release was performed and lateral capsule was released with a Bovie. The medial capsule was relaxed with extensive stripping of the medial capsule and MCL attachment. The knee was manipulated without a polyethylene in place with flexion of 135 degrees achieved.
A trial 8 mm polyethylene was then inserted. Flexion to 130 degrees was achieved. Ligamentous balance and stability was still quite good throughout range of motion. He had full extension just past zero degrees as well.
The trial was removed. Thorough pulsatile lavage was performed with antibiotic irrigation solution throughout the knee. The 8 mm thick polyethylene was then impacted. The knee capsule and extensor mechanism was then repaired using running 0 V-Loc suture in 90 degrees of flexion. The subcutaneous tissues were closed with interrupted and running 2-0 Vicryl. Skin was closed with staples. Sterile dressing was applied.