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The anterior tibial tubercleplasty, commonly referred to as a Maquet type procedure, is a surgical intervention aimed at addressing patellar instability. This procedure is particularly relevant for patients experiencing issues with the tracking of the patella, which can lead to pain and functional limitations. During the operation, the surgeon makes a precise incision lateral to the patella, extending across the tibial tuberosity and continuing distally along the anterior ridge of the tibia. This approach allows for the elevation of the muscles that cover the anterior compartment, providing access to the underlying structures. The procedure involves careful exposure of the medial and lateral borders of the patellar tendon and the tibial tuberosity, which is crucial for the subsequent steps. The surgeon then makes an incision through the periosteum, located distal to the tuberosity, to facilitate the repositioning of the tibial tuberosity. K-wires are strategically inserted to guide the osteotomy cuts, ensuring that the tibial tuberosity can be accurately repositioned to achieve optimal patellar alignment within the intercondylar groove. The final assessment of patellar tracking is critical, as it determines whether any adjustments are necessary to prevent under- or overcorrection. Once the desired alignment is confirmed, the tibial tuberosity is secured in place using one or more screws, completing the procedure and aiming to restore proper knee function.
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The anterior tibial tubercleplasty is indicated for patients suffering from patellar instability, which may manifest as recurrent dislocations or subluxations of the patella. This condition can lead to significant pain, functional impairment, and decreased quality of life. The procedure is particularly beneficial for individuals who have not responded to conservative management strategies, such as physical therapy or bracing, and who require surgical intervention to stabilize the patella and improve knee function.
The anterior tibial tubercleplasty involves several critical procedural steps to ensure successful outcomes. Initially, the surgeon makes an incision lateral to the patella, which crosses the tibial tuberosity and extends distally along the anterior ridge of the tibia. This incision allows for the elevation of the muscles overlying the anterior compartment, providing necessary access to the underlying anatomical structures. Following this, the medial and lateral borders of the patellar tendon and tibial tuberosity are carefully exposed to facilitate the next steps of the procedure.
After the anterior tibial tubercleplasty, patients typically undergo a recovery period that may involve immobilization of the knee to allow for healing. Physical therapy is often initiated to restore range of motion and strengthen the surrounding musculature. Patients are monitored for any signs of complications, such as infection or improper healing. The expected recovery timeline can vary, but most individuals can anticipate a gradual return to normal activities as they progress through rehabilitation, with the goal of achieving improved patellar stability and knee function.
| Short Descr | REPAIR DEGENERATED KNEECAP | Medium Descr | ANTERIOR TIBIAL TUBERCLEPLASTY | Long Descr | Anterior tibial tubercleplasty (eg, Maquet type procedure) | 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 | Non office-based surgical procedure added in CY 2008 or later; 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 | 142 - Partial excision bone |
| 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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