Radical Resection Right distal femur?

Hi All,

One of our doctors wants to bill 20680 and 27365 for the procedure down below. This is clearly not correct and I am inquiring if anyone has any input on what would be a code we could bill, if any besides the 20680.


INDICATION FOR PROCEDURE:  This is a 28-year-old male, who injured their right knee when shot. They underwent ORIF of distal femur and proximal tibia. Unfortunately, he developed a malunion with a dysfunctional limb. He developed significant post-traumatic DJD. Due to this the decision was made to intervene surgically in the form of removal of hardware, distal femoral resection and TKA with allograft.  The risks and benefits of the procedure were explained to the patient, which included but were not limited to, infection, bleeding, neurovascular injury, need for further surgery, and risks of anesthesia.  All questions were answered and informed consent was obtained. Due to the complexity of this case, my partner, Dr. ____, performed the TKA portion and will dictate a separate op note.

 

PROCEDURE IN DETAIL:  The patient was seen in the holding area by surgical team and the right lower extremity was marked.  The patient was brought back to the operating room, where general anesthesia was administered.  The patient was then positioned supine on a radiolucent table with all bony prominences padded.  The right lower extremity was prepped and draped in the usual sterile fashion.  A formal time-out was performed. Ancef and Vanco were given as preoperative antibiotic.  The knee was approached through a standard midline incision, based off the tibial tubercle, centered over the patella. Sharp dissection was taken down.  Flaps were raised and medial parapatellar arthrotomy was made.  Medial and lateral sleeves were raised off of the proximal tibia. At this point, attention was then turned to the distal femur.  The distal femur was exposed. The distal femur hardware was fully exposed and removed without difficulty. A distal femur cut was made roughly 10cm proximal to the joint line and the distal femur, in additio to significant posterior heterotopic ossification was removed. The medial epicondyle was osteotomized with the MCL attached to later attach to the allograft. This was all done without the tourniquet inflated and hemostasis was achieved without any evidence of serious vascular injury. Attention was then turned to the proximal tibia. Through small stab incisions, the screws through the tibial plate were all removed. At this point, the case was turned over to my partner, Dr. ___, to perform the TKA. Once the TKA was completed, the medial epicondyle was attached to the distal femoral allograft with a 4.5 partially threaded cannulated screw. The junction of the distal femur allograft and native femur as well as the medial epicondyle was augmented with Vivigen. The wound was irrigated thoroughly, hemostasis achieved, and closed in a layered fashion over 2 JP drains with #1 Vicryl, 2-0 Vicryl, and 3-0 nylon.  A sterile dressing was placed.  The patient tolerated the procedure well.

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