kkidd91
Contributor
Please advise how you would code this case, any insight is very much appreciated. Would you select the unlisted code 27599 or code only for the hamstring repair (27385) I am unsure if suture of hamstring would be appropriate as anchors were used. I also see the mention of the tenotomy of semimembranosus however I do not see where the physician divides the tendon and incised transversely at two levels.
PREOPERATIVE DIAGNOSIS: Refractory right proximal hamstring tendinopathy.
POSTOPERATIVE DIAGNOSIS: Refractory right proximal hamstring tendinopathy.
OPERATIONS PERFORMED: Right debridement and tenotomy of semimembranosus with reattachment and repair of the right proximal hamstring tendon
DESCRIPTION OF PROCEDURE:
The patient was met in the preoperative holding area. I again went through the risks and benefits and discussed postoperative course. The operative leg was marked, and discussed with the Anesthesia and consent was signed, and she was wheeled back to the operating room and underwent general endotracheal anesthesia and was placed in the prone position. All bony prominences were well padded. Her right buttock and leg was sterilely prepped and draped in a standard orthopedic fashion. We called a time-out confirming patient, laterality, implants, and administration of antibiotics. Once everyone agreed to proceed along the gluteal fold, I placed 30 mL of 0.5% with epinephrine, and then, I again used ChloraPrep to prep the gluteal fold. We placed Ioban around the edges of the surgical field. I then made a 6-cm transverse incision through the gluteal fold and went down through the skin and subcutaneous tissue down to the gluteal fascia. This was then excised to repair later. I protected the nerves throughout. I palpated the ischial tuberosity and went through the ischial bursa to expose the hamstring tendons. The more medial hamstring tendon appeared quite normal. I went more lateral based and made sure that is where the sclerosis was as well as the salivary like appearance of the tendon. I transected the tendon approximately 2 cm at the insertion and was going to tie the tissue into the muscle belly of the remaining hamstring tendons, but given the patient's quality of tissue, I chose to place an anchor into the ischial tuberosity. I prepped the ischial tuberosity. It was quite sclerotic appearing and jagged in nature. I used a curette to prep the area, and then, I placed a 4.75 SwiveLock anchor. Given the majority of what I released, I placed a running locking tape into a corkscrew anchor, and I tightened it down and tied in square knots. It appropriately tensioned and was snugged up against the ischial tuberosity. Given that I again released the entirety of the tendon or the hamstring, I did not feel that there was enough room for me to place another SutureTape running locking stitch through, after I did up and down, so I removed the other tape before I had tightened it down. Following this, I irrigated and made sure there were no lysis of adhesions, and I freed them up from the sciatic nerve laterally. The posterior femoral cutaneous nerve was protected throughout and was intact. Following this, we irrigated with copious amounts of saline and closed the gluteal fascia with #0 Vicryl, followed by subcutaneous layer with 2-0 Vicryl, followed by a running Monocryl 3-0 stitch in the gluteal fold. Dermabond and Steri-Strips were placed, followed by an Aquacel waterproof dressing. All questions and concerns were answered to her husband's satisfaction. The patient was transferred to PACU in stable condition.
PREOPERATIVE DIAGNOSIS: Refractory right proximal hamstring tendinopathy.
POSTOPERATIVE DIAGNOSIS: Refractory right proximal hamstring tendinopathy.
OPERATIONS PERFORMED: Right debridement and tenotomy of semimembranosus with reattachment and repair of the right proximal hamstring tendon
DESCRIPTION OF PROCEDURE:
The patient was met in the preoperative holding area. I again went through the risks and benefits and discussed postoperative course. The operative leg was marked, and discussed with the Anesthesia and consent was signed, and she was wheeled back to the operating room and underwent general endotracheal anesthesia and was placed in the prone position. All bony prominences were well padded. Her right buttock and leg was sterilely prepped and draped in a standard orthopedic fashion. We called a time-out confirming patient, laterality, implants, and administration of antibiotics. Once everyone agreed to proceed along the gluteal fold, I placed 30 mL of 0.5% with epinephrine, and then, I again used ChloraPrep to prep the gluteal fold. We placed Ioban around the edges of the surgical field. I then made a 6-cm transverse incision through the gluteal fold and went down through the skin and subcutaneous tissue down to the gluteal fascia. This was then excised to repair later. I protected the nerves throughout. I palpated the ischial tuberosity and went through the ischial bursa to expose the hamstring tendons. The more medial hamstring tendon appeared quite normal. I went more lateral based and made sure that is where the sclerosis was as well as the salivary like appearance of the tendon. I transected the tendon approximately 2 cm at the insertion and was going to tie the tissue into the muscle belly of the remaining hamstring tendons, but given the patient's quality of tissue, I chose to place an anchor into the ischial tuberosity. I prepped the ischial tuberosity. It was quite sclerotic appearing and jagged in nature. I used a curette to prep the area, and then, I placed a 4.75 SwiveLock anchor. Given the majority of what I released, I placed a running locking tape into a corkscrew anchor, and I tightened it down and tied in square knots. It appropriately tensioned and was snugged up against the ischial tuberosity. Given that I again released the entirety of the tendon or the hamstring, I did not feel that there was enough room for me to place another SutureTape running locking stitch through, after I did up and down, so I removed the other tape before I had tightened it down. Following this, I irrigated and made sure there were no lysis of adhesions, and I freed them up from the sciatic nerve laterally. The posterior femoral cutaneous nerve was protected throughout and was intact. Following this, we irrigated with copious amounts of saline and closed the gluteal fascia with #0 Vicryl, followed by subcutaneous layer with 2-0 Vicryl, followed by a running Monocryl 3-0 stitch in the gluteal fold. Dermabond and Steri-Strips were placed, followed by an Aquacel waterproof dressing. All questions and concerns were answered to her husband's satisfaction. The patient was transferred to PACU in stable condition.