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Reconstruction of a dislocating patella with patellectomy is a surgical procedure aimed at addressing the instability of the patella, which can lead to recurrent dislocations. This procedure involves the removal of the patella, a bone that is crucial for knee function, particularly in terms of strength and movement. The surgery begins with a longitudinal incision that splits the tendon over the patella, allowing for careful dissection of the quadriceps tendon and patellar ligament from the bone. Once the patella is excised, the resulting defect is closed longitudinally. To mitigate the impact of patellectomy on knee function, the quadriceps muscle may be repositioned laterally and distally over the defect. This repositioning, known as plication, aims to enhance the angle of insertion of the quadriceps muscle at the sagittal plane, which is essential for maintaining strength and function in the knee following the removal of the patella. This procedure is particularly relevant for patients experiencing chronic patellar dislocation, as it seeks to restore stability and improve overall knee mechanics.
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The procedure of reconstruction of a dislocating patella with patellectomy is indicated for patients who experience recurrent dislocations of the patella, which can lead to significant pain, instability, and functional impairment. This surgical intervention is typically considered when conservative treatments, such as physical therapy or bracing, have failed to provide adequate relief or stabilization. The primary indications for this procedure include:
The procedure for reconstruction of a dislocating patella with patellectomy involves several critical steps to ensure successful removal of the patella and restoration of knee function. The steps are as follows:
Post-procedure care following reconstruction of a dislocating patella with patellectomy involves several important considerations to ensure optimal recovery. Patients are typically monitored for any signs of complications, such as infection or excessive swelling. Rehabilitation is a crucial component of recovery, and physical therapy is often initiated to restore range of motion and strengthen the surrounding muscles. Patients may be advised to limit weight-bearing activities for a specified period to allow for proper healing. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the rehabilitation program. Overall, the goal of post-procedure care is to facilitate a successful recovery and to restore knee function as effectively as possible.
| Short Descr | REVISION/REMOVAL OF KNEECAP | Medium Descr | RCNSTJ DISLC PATELLA W/PATELLECTOMY | Long Descr | Reconstruction of dislocating patella; with patellectomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 152 - Arthroplasty knee |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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