lcole7465
Expert
I code for anesthesia and have the below procedure that is throwing me off.. Any help in this matter would be greatly appreciated.
Below is the procedure that was performed along with a description of the procedure performed. I have not seen this procedure, and the only information I have been able to find is that this a form of endoscopic procedures. I am leaning towards 28120 for the osteomyelitis another coder is saying an arthroscopic debridement. I think what's throwing me off the DaVinci exoscopic assisted approach.
Da Vinci exoscopic-assisted approach for the left foot
debridement, skin, subcutaneous tissue, and bone debridement including the
fascia of the plantar surface of the foot. Wide debridement of a bone cavity
osteomyelitis of calcaneus bone.
DESCRIPTION OF PROCEDURE: The patient under supine position under general anesthesia with endotracheal intubation, the left leg was properly elevated and secured with several blankets. The skin area revealed a wound that had a hypertrophic skin and the measurement of 14 x 12 mm in the center part of the calcaneus, rear portion of the calcaneus. The patient was prepared with Betadine and sterile drapes were applied. Betadine-impregnated Vi-Drape was used. The robotic system, which is the XI DaVinci system was brought from the right side of the patient in an oblique fashion. We used a 0 degree 8 mm scope. As we completed the engagement we used a scalpel blade for the electrocautery on the right and ____ instrumentation on the left. As we positioned the robot in an exoscopic approach, the surgeon went to the console and the treatment was initiated with electrocautery. The area of 7 x 4 mm that was definitely located at the center or target of the anatomical area and we did use a wide margin of at least 20 mm, 10 mm each in a circular fashion to remove the skin and subcutaneous tissue. Initially a very thick portion of the skin, hypertrophic was the one that was excised. We got some subcutaneous tissue underneath and we had a very good dissection of the soft tissue. The dissection was carried on with the robotic system and we had a circumferentially actually a cylindrical shape excision of soft tissue including subcutaneous tissue and fascia. The bone was exposed. We had some hyperactive, sick, and irregular bone. The area of the bone exposes approximately 12 x 14 mm in length and width. We the transferred the surgeon to the standby position and the surgeon with the assistant of the 10 mm 0 degree scope performed the eradication of the bone involvement with the Stryker rotator blade. All this was performed with exoscopic approach under direct vision and at one point the rotator blade from Stryker broke into the cavity and that cavity was probably defending myelitis reaction. The cavity was estimated probably in another 10 x 12 mm in size. There was no pause. The cavity was therefore opened and more bone had to be debrided in order to remove completely that portion of the bone and the cavity. Separate specimens of bone pieces were removed and submitted for culture as the label of the bone. The soft tissue had been already submitted. We washed the wound very carefully with saline bacitracin antibiotic mixture solution and we had a very good blood supply of the tissues and particularly all the bone was cleared. We had digital inspection of the bone cavity. We did remove essentially all the bone that was in contact presumably with the area of the inflammatory process from the skin. As we finished washing the wounds, we then applied amniotic membrane or Epifix, 2 membranes were applied reaching the area of the cavity and the scalenus this cavity and the surface of the bone of the calcaneus. As the Epifix membrane was placed in the cavity was
secured with Adaptic and then pressure dressing with 4 x 4 Kerlix and Kerlix
rolled in a gentle and smooth dressing to protect the area just operated.
Below is the procedure that was performed along with a description of the procedure performed. I have not seen this procedure, and the only information I have been able to find is that this a form of endoscopic procedures. I am leaning towards 28120 for the osteomyelitis another coder is saying an arthroscopic debridement. I think what's throwing me off the DaVinci exoscopic assisted approach.
Da Vinci exoscopic-assisted approach for the left foot
debridement, skin, subcutaneous tissue, and bone debridement including the
fascia of the plantar surface of the foot. Wide debridement of a bone cavity
osteomyelitis of calcaneus bone.
DESCRIPTION OF PROCEDURE: The patient under supine position under general anesthesia with endotracheal intubation, the left leg was properly elevated and secured with several blankets. The skin area revealed a wound that had a hypertrophic skin and the measurement of 14 x 12 mm in the center part of the calcaneus, rear portion of the calcaneus. The patient was prepared with Betadine and sterile drapes were applied. Betadine-impregnated Vi-Drape was used. The robotic system, which is the XI DaVinci system was brought from the right side of the patient in an oblique fashion. We used a 0 degree 8 mm scope. As we completed the engagement we used a scalpel blade for the electrocautery on the right and ____ instrumentation on the left. As we positioned the robot in an exoscopic approach, the surgeon went to the console and the treatment was initiated with electrocautery. The area of 7 x 4 mm that was definitely located at the center or target of the anatomical area and we did use a wide margin of at least 20 mm, 10 mm each in a circular fashion to remove the skin and subcutaneous tissue. Initially a very thick portion of the skin, hypertrophic was the one that was excised. We got some subcutaneous tissue underneath and we had a very good dissection of the soft tissue. The dissection was carried on with the robotic system and we had a circumferentially actually a cylindrical shape excision of soft tissue including subcutaneous tissue and fascia. The bone was exposed. We had some hyperactive, sick, and irregular bone. The area of the bone exposes approximately 12 x 14 mm in length and width. We the transferred the surgeon to the standby position and the surgeon with the assistant of the 10 mm 0 degree scope performed the eradication of the bone involvement with the Stryker rotator blade. All this was performed with exoscopic approach under direct vision and at one point the rotator blade from Stryker broke into the cavity and that cavity was probably defending myelitis reaction. The cavity was estimated probably in another 10 x 12 mm in size. There was no pause. The cavity was therefore opened and more bone had to be debrided in order to remove completely that portion of the bone and the cavity. Separate specimens of bone pieces were removed and submitted for culture as the label of the bone. The soft tissue had been already submitted. We washed the wound very carefully with saline bacitracin antibiotic mixture solution and we had a very good blood supply of the tissues and particularly all the bone was cleared. We had digital inspection of the bone cavity. We did remove essentially all the bone that was in contact presumably with the area of the inflammatory process from the skin. As we finished washing the wounds, we then applied amniotic membrane or Epifix, 2 membranes were applied reaching the area of the cavity and the scalenus this cavity and the surface of the bone of the calcaneus. As the Epifix membrane was placed in the cavity was
secured with Adaptic and then pressure dressing with 4 x 4 Kerlix and Kerlix
rolled in a gentle and smooth dressing to protect the area just operated.
