CassyWelzen
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Hello,
Can anyone assist on the op note below? I know 29893 & 28119 CCI edit together but feel it was all done endoscopically and 29893 & 29999 should be billed. Has anyone ever bill the unlisted procedure in comparison to 28119?
Pre-Operative Diagnosis: 1. Plantar fasciitis with heel spur, right
Post-Operative Diagnosis: Same
Procedure: 1. Endoscopic plantar fasciotomy with heel spur resection, right
Anesthesia: MAC with local
Hemostasis: Pneumatic Ankle TQ 250 mmHg
EBL: Minimal
Procedure:
The patient was brought to the operating room and placed supine on the operating room table. Once adequate MAC anesthesia was obtained the right foot was then prepped and draped in the usual aseptic fashion. 20 cc of 2% lidocaine and 0.5% marcaine plain in a 1:1 distribution was administered about the surgical site. Upon exsanguination of the right foot with an esmark bandage and placement of padding at the ankle, the pneumatic ankle tourniquet was inflated to 250mHG.
Surgery began in the following manner:
Attention was then directed to the medial aspect of the right heel where a linear incision was made. The incision was deepened via blunt dissection with care being taken to avoid any and all vital structures. The medial proximal portion of the plantar fascia was isolated and identified. Utilizing a curved Kelly hemostat and a disector a channel was made planter to the plantar fascia at this level from medial to lateral. A slotted cannula aided by a trochar tip was then inserted through the channel plantar to the plantar fascia from the direction of medial to lateral. A second incision was made and the cannula was pushed through, and the trocar removed.
The endoscopic camera was placed into the cannula. The plantar fascia was visualized. Its margins both medial and laterally were noted and identified (via a fatty plug). The plantar fascia was incised by a curved endoscopic blade. It was noted that all appropriate fibers were excised. The plantar fasciia was noted to again be at least 3 times normal thickness.
Upon completion of the fasciotomy, a power rasp was introduced through the medial incision and the plantar heel spur was removed with confirmation of C-arm. A second plantar heel spur, mid arch, was encountered, but it was determined to be in an area of plantar foot muscle origin, and was left alone.
Can anyone assist on the op note below? I know 29893 & 28119 CCI edit together but feel it was all done endoscopically and 29893 & 29999 should be billed. Has anyone ever bill the unlisted procedure in comparison to 28119?
Pre-Operative Diagnosis: 1. Plantar fasciitis with heel spur, right
Post-Operative Diagnosis: Same
Procedure: 1. Endoscopic plantar fasciotomy with heel spur resection, right
Anesthesia: MAC with local
Hemostasis: Pneumatic Ankle TQ 250 mmHg
EBL: Minimal
Procedure:
The patient was brought to the operating room and placed supine on the operating room table. Once adequate MAC anesthesia was obtained the right foot was then prepped and draped in the usual aseptic fashion. 20 cc of 2% lidocaine and 0.5% marcaine plain in a 1:1 distribution was administered about the surgical site. Upon exsanguination of the right foot with an esmark bandage and placement of padding at the ankle, the pneumatic ankle tourniquet was inflated to 250mHG.
Surgery began in the following manner:
Attention was then directed to the medial aspect of the right heel where a linear incision was made. The incision was deepened via blunt dissection with care being taken to avoid any and all vital structures. The medial proximal portion of the plantar fascia was isolated and identified. Utilizing a curved Kelly hemostat and a disector a channel was made planter to the plantar fascia at this level from medial to lateral. A slotted cannula aided by a trochar tip was then inserted through the channel plantar to the plantar fascia from the direction of medial to lateral. A second incision was made and the cannula was pushed through, and the trocar removed.
The endoscopic camera was placed into the cannula. The plantar fascia was visualized. Its margins both medial and laterally were noted and identified (via a fatty plug). The plantar fascia was incised by a curved endoscopic blade. It was noted that all appropriate fibers were excised. The plantar fasciia was noted to again be at least 3 times normal thickness.
Upon completion of the fasciotomy, a power rasp was introduced through the medial incision and the plantar heel spur was removed with confirmation of C-arm. A second plantar heel spur, mid arch, was encountered, but it was determined to be in an area of plantar foot muscle origin, and was left alone.
