cclarson
Guru
Hello Everyone, I'm not sure how to code this complication. The doctor was trying to remove cartilage form the metatarsal head and accidently shattered the metatarsal head itself. How would I code the ICD-10 dx for this complication? Any help would be greatly appreciated! 
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Severe hallux abductovalgus, left foot.
OPERATION PERFORMED:
First metatarsal joint arthrodesis, left foot.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed on the operating table in the supine position; at which time, IV sedation was achieved, and general inhalational anesthesia was induced. The foot was prepped and draped in the usual sterile manner. A tourniquet was applied to the midthigh area. The foot was exsanguinated, and the tourniquet was inflated to 250 mmHg. Additional anesthesia was injected with a local block around the base of the first metatarsal using 0.5% Marcaine plain. Attention was directed to the dorsal aspect of the left first metatarsophalangeal joint where a linear incision was created in the skin directly overlying the joint structures. Dissection was carried through the subcutaneous layers. Blood vessels encountered were cauterized. Sharp and blunt dissection was carried into the first interspace. The deep transverse intermetatarsal ligament was identified, isolated, and transected. A lateral capsulotomy was performed, and the fibular collateral ligament was severed completing the lateral release. The linear capsulotomy was then performed in the dorsomedial aspect of the joint capsule. The metatarsal head was delivered into the surgical wound. The base of the proximal phalanx was then also aggressively debrided to expose the cartilage, and the head was prepared for resection of the cartilaginous surface. Using a conical reamer, the cup and cone device was used to attempt to remove the cartilage from the head of the first metatarsal. Unfortunately, there was considerable fragility of the metatarsal head, and the metatarsal head shattered into several pieces at the cartilaginous surface to a regular shape; therefore, there was no need for condition, in which case a cup and cone fusion would be necessary; therefore, we decided to abandon this technique and go to plate fixation. Because of the damage of the metatarsal head, we needed to remove some of the fractured pieces of cartilage. This was all removed from the area. The base of the proximal phalanx was then resected using an oscillating saw instead the conical reamer.
The two cut ends of the bone were then reapproximated to ensure that the toe would remain parallel to the ground and get appropriate ground purchase with fixation. A K-wire was then driven from the tip of the toe through the base of the phalanx engaging the shaft of the proximal portion of the metatarsal. This temporarily fixated the arthrodesis site. It was checked with simulated weightbearing to ensure that the toe would be in a normal position for toe purchase. Satisfied with the fixation that would be achieved with this positioning, the medial aspect of the metatarsal was reshaped a little bit using the oscillating saw, and a 6-hole Arthrex compression plate was then bent appropriately to fit the size of the bone and 6 individuals nonlocking screws were then used to fixate the plate to the medial aspect of the first metatarsophalangeal joint. Satisfied with the fixation, it should be noted that the C-arm image was used throughout the entire fixation process. The reduction of the first metatarsal angle was noted to be considerable. The fusion site was solid. The arthrodesis site appeared to be well fixated. The surgical site was then flushed with sterile saline. The joint capsule was closed with 3-0 Vicryl. The subcutaneous layers were closed with 4-0 Vicryl, and the skin was closed with 4-0 nylon. A dry sterile dressing was applied to the foot. The tourniquet was deflated. Immediate color return was noticed to be normal to all digits. After a brief stay in recovery, the patient will be discharged to home with appropriate postoperative instructions.
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Severe hallux abductovalgus, left foot.
OPERATION PERFORMED:
First metatarsal joint arthrodesis, left foot.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room and placed on the operating table in the supine position; at which time, IV sedation was achieved, and general inhalational anesthesia was induced. The foot was prepped and draped in the usual sterile manner. A tourniquet was applied to the midthigh area. The foot was exsanguinated, and the tourniquet was inflated to 250 mmHg. Additional anesthesia was injected with a local block around the base of the first metatarsal using 0.5% Marcaine plain. Attention was directed to the dorsal aspect of the left first metatarsophalangeal joint where a linear incision was created in the skin directly overlying the joint structures. Dissection was carried through the subcutaneous layers. Blood vessels encountered were cauterized. Sharp and blunt dissection was carried into the first interspace. The deep transverse intermetatarsal ligament was identified, isolated, and transected. A lateral capsulotomy was performed, and the fibular collateral ligament was severed completing the lateral release. The linear capsulotomy was then performed in the dorsomedial aspect of the joint capsule. The metatarsal head was delivered into the surgical wound. The base of the proximal phalanx was then also aggressively debrided to expose the cartilage, and the head was prepared for resection of the cartilaginous surface. Using a conical reamer, the cup and cone device was used to attempt to remove the cartilage from the head of the first metatarsal. Unfortunately, there was considerable fragility of the metatarsal head, and the metatarsal head shattered into several pieces at the cartilaginous surface to a regular shape; therefore, there was no need for condition, in which case a cup and cone fusion would be necessary; therefore, we decided to abandon this technique and go to plate fixation. Because of the damage of the metatarsal head, we needed to remove some of the fractured pieces of cartilage. This was all removed from the area. The base of the proximal phalanx was then resected using an oscillating saw instead the conical reamer.
The two cut ends of the bone were then reapproximated to ensure that the toe would remain parallel to the ground and get appropriate ground purchase with fixation. A K-wire was then driven from the tip of the toe through the base of the phalanx engaging the shaft of the proximal portion of the metatarsal. This temporarily fixated the arthrodesis site. It was checked with simulated weightbearing to ensure that the toe would be in a normal position for toe purchase. Satisfied with the fixation that would be achieved with this positioning, the medial aspect of the metatarsal was reshaped a little bit using the oscillating saw, and a 6-hole Arthrex compression plate was then bent appropriately to fit the size of the bone and 6 individuals nonlocking screws were then used to fixate the plate to the medial aspect of the first metatarsophalangeal joint. Satisfied with the fixation, it should be noted that the C-arm image was used throughout the entire fixation process. The reduction of the first metatarsal angle was noted to be considerable. The fusion site was solid. The arthrodesis site appeared to be well fixated. The surgical site was then flushed with sterile saline. The joint capsule was closed with 3-0 Vicryl. The subcutaneous layers were closed with 4-0 Vicryl, and the skin was closed with 4-0 nylon. A dry sterile dressing was applied to the foot. The tourniquet was deflated. Immediate color return was noticed to be normal to all digits. After a brief stay in recovery, the patient will be discharged to home with appropriate postoperative instructions.