Sara82
Guru
Does anyone have any information regarding if 27132 and 20680-59 are included? I though that if the hardware was removed from a total seperate incision that it was seperatly billable? Does this rule not apply with CPT 27132? Brief report below..
We set about
doing the metal extraction hardware removal first. Sharp
dissection was carried out down to the level of the fascia. The
fascia was split in line with the lateral aspect of the femur and
curved posteriorly to the gluteus maximus myofascia. The lateral
aspect of the vastus lateralis was identified. We could palpate
the lateral edge of the plate. We were then able to split the
myofascia of the vastus lateralis and split right down onto the
plate through the scar tissue. Painstaking effort was taken to
preserve the vastus lateralis muscle. We identified the proximal
portion of the plate and the locking screw. We identified the
lateral border of the plate and with a key elevator elevated the
soft tissue off this until we identified all the screws. The 4
screws were backed out in individual fashion. The locking screw
from the compression device was removed as well. We then
painstakingly freed up the margins of the plate and removed the
plate. Using the large T-handle, the large sliding hip screw was
removed from the femoral head as well. The wound was copiously
irrigated. The screw holes were curetted and rongeured with a
nice smooth border. We then closed the vastus lateralis over the
lateral femur with 0 Vicryl suture in interrupted fashion. Happy
that we had removed the plate without any difficulties and closed
this portion of the wound over the exposed femur, we proceeded
with the hip replacement.
We set about
doing the metal extraction hardware removal first. Sharp
dissection was carried out down to the level of the fascia. The
fascia was split in line with the lateral aspect of the femur and
curved posteriorly to the gluteus maximus myofascia. The lateral
aspect of the vastus lateralis was identified. We could palpate
the lateral edge of the plate. We were then able to split the
myofascia of the vastus lateralis and split right down onto the
plate through the scar tissue. Painstaking effort was taken to
preserve the vastus lateralis muscle. We identified the proximal
portion of the plate and the locking screw. We identified the
lateral border of the plate and with a key elevator elevated the
soft tissue off this until we identified all the screws. The 4
screws were backed out in individual fashion. The locking screw
from the compression device was removed as well. We then
painstakingly freed up the margins of the plate and removed the
plate. Using the large T-handle, the large sliding hip screw was
removed from the femoral head as well. The wound was copiously
irrigated. The screw holes were curetted and rongeured with a
nice smooth border. We then closed the vastus lateralis over the
lateral femur with 0 Vicryl suture in interrupted fashion. Happy
that we had removed the plate without any difficulties and closed
this portion of the wound over the exposed femur, we proceeded
with the hip replacement.