sara lamb
Contributor
Is the following op note coded 28122 x 2? Or does reporting cpt 28122 once cover it? Any advice appreciated as well as include any reference if possible - Thanks!
Attention was directed to the dorsal aspect of the right foot where a linear incision was made with a #15 between the second and third metatarsal. All bleeders were identified, cauterized and ligated as necessary. All vital neurovascular structures were identified and safely retracted. Blunt dissection was carried down to the level of the periosteum which was incised. 2-3 cc of purulence was exposed and deep cultures obtained. With the 2nd and 3rd metatarsals exposed, a sagittal saw was used to partially resect each metatarsal individually proximal to level of good, hard cortical bone. A proximal clearing margin was obtained of each metatarsal and sent to pathology for gross identification and to rule out osteomyelitis. The incision was then debrided with a #15 blade and the Misonix System of as much non viable tissue as possible. The tourniquet was deflated and hemostasis obtained prior to closure. The incision was closed with 2-0 Vicryl, 4-0 Vicryl and 3-0 Prolene. A penrose drain was placed into the plantar ulceration and the incision dressed with betadine, xeroform, 4x4s, Kerlix and an ACE wrap for gentle compression. The patient was placed into a surgical shoe. The patient will be started on Augmentin 875 mg BID pending culture results. The patient was awaken from anesthesia and taken to PACU with neurovascular status intact. Patient tolerated the procedure well without complication.
Attention was directed to the dorsal aspect of the right foot where a linear incision was made with a #15 between the second and third metatarsal. All bleeders were identified, cauterized and ligated as necessary. All vital neurovascular structures were identified and safely retracted. Blunt dissection was carried down to the level of the periosteum which was incised. 2-3 cc of purulence was exposed and deep cultures obtained. With the 2nd and 3rd metatarsals exposed, a sagittal saw was used to partially resect each metatarsal individually proximal to level of good, hard cortical bone. A proximal clearing margin was obtained of each metatarsal and sent to pathology for gross identification and to rule out osteomyelitis. The incision was then debrided with a #15 blade and the Misonix System of as much non viable tissue as possible. The tourniquet was deflated and hemostasis obtained prior to closure. The incision was closed with 2-0 Vicryl, 4-0 Vicryl and 3-0 Prolene. A penrose drain was placed into the plantar ulceration and the incision dressed with betadine, xeroform, 4x4s, Kerlix and an ACE wrap for gentle compression. The patient was placed into a surgical shoe. The patient will be started on Augmentin 875 mg BID pending culture results. The patient was awaken from anesthesia and taken to PACU with neurovascular status intact. Patient tolerated the procedure well without complication.