What CPT do you code for Pes Anserinus debridement of bursa and tenolysis with semitendinosus and gracilis tendons? This is a Medicare patient. See op report below. We looked at 27599 but this is not covered by Medicare.
FINDINGS AT THE TIME OF SURGERY: Evaluation of the pes anserinus noted significant scaring and significant adhesions between the semitendinosus with the surrounding gastroc fascia. There were adhesions between the two tendons as well as on the undersurface of the sartorius. The bursa itself was adhered to this as well.
The tendons were stripped subperiosteally off the tibial attachment and then off their musculotendinous junctions.
PROCEDURE: With the patient under excellent anesthetic and after given IV antibiotics, evaluation under anesthesia was performed.
The knee was then prepped and draped in usual sterile manner for left knee surgery in the leg holder position.
Esmarch bandage was used to exsanguinate the left lower extremity blood and tourniquet was elevated to 275 mmHg.
A 4 cm longitudinal incision was made over the proposed area of the pes anserinus bursa. It was brought down through the subcutaneous tissue. Care was taken to avoid injury to neurovascular structures. Bleeding was controlled with electrical hemostasis.
Dissection was then carried down to the sartorius expansion. At this point, the multiple varicosities in the leg were causing a problem with what appeared to be a venous tourniquet.
After several attempts to control bleeding, the tourniquet was deflated and actually the bleeding diminished significantly. At this point, the sartorius expansion was identified and incised exposing the underlying semitendinosus and gracilis tendons. They were elevated off the adhesive attachments between the sartorius as well as underlying bursa and then between themselves. The tendons were then isolated from the surrounding attachments to the fascia.
Using anterior cruciate ligament tendon stripper, the two tendons were stripped off the proximal musculotendinous junctions. They were then excised off of their periosteal attachment.
Wound was copiously irrigated. Bleeding was controlled with electrical hemostasis. Sartorius expansion was loosely approximated with 0 Vicryl. Skin was then reapproximated using 2-0 and 3-0 Vicryl in the deep subcutaneous layer and a running subcuticular stitch of 3-0 monofilament absorbable suture to reapproximate the skin. Steri-Strips were applied. Sterile dressings were applied over this. The patient was awakened and brought to recovery room in a stable condition.
Any assistance would be appreciated.
Thank you
Frances
FINDINGS AT THE TIME OF SURGERY: Evaluation of the pes anserinus noted significant scaring and significant adhesions between the semitendinosus with the surrounding gastroc fascia. There were adhesions between the two tendons as well as on the undersurface of the sartorius. The bursa itself was adhered to this as well.
The tendons were stripped subperiosteally off the tibial attachment and then off their musculotendinous junctions.
PROCEDURE: With the patient under excellent anesthetic and after given IV antibiotics, evaluation under anesthesia was performed.
The knee was then prepped and draped in usual sterile manner for left knee surgery in the leg holder position.
Esmarch bandage was used to exsanguinate the left lower extremity blood and tourniquet was elevated to 275 mmHg.
A 4 cm longitudinal incision was made over the proposed area of the pes anserinus bursa. It was brought down through the subcutaneous tissue. Care was taken to avoid injury to neurovascular structures. Bleeding was controlled with electrical hemostasis.
Dissection was then carried down to the sartorius expansion. At this point, the multiple varicosities in the leg were causing a problem with what appeared to be a venous tourniquet.
After several attempts to control bleeding, the tourniquet was deflated and actually the bleeding diminished significantly. At this point, the sartorius expansion was identified and incised exposing the underlying semitendinosus and gracilis tendons. They were elevated off the adhesive attachments between the sartorius as well as underlying bursa and then between themselves. The tendons were then isolated from the surrounding attachments to the fascia.
Using anterior cruciate ligament tendon stripper, the two tendons were stripped off the proximal musculotendinous junctions. They were then excised off of their periosteal attachment.
Wound was copiously irrigated. Bleeding was controlled with electrical hemostasis. Sartorius expansion was loosely approximated with 0 Vicryl. Skin was then reapproximated using 2-0 and 3-0 Vicryl in the deep subcutaneous layer and a running subcuticular stitch of 3-0 monofilament absorbable suture to reapproximate the skin. Steri-Strips were applied. Sterile dressings were applied over this. The patient was awakened and brought to recovery room in a stable condition.
Any assistance would be appreciated.
Thank you
Frances