nsteinhauser
Expert
- Messages
- 472
- Location
- Two Harbors, MN
I want to use 28118 but this was not a Hagglund's. It was 'large osteophytes.' Also looking at 28200 (per CPT ASST May 2011) for Achille's debridement.
OP NOTE:
Incision was made midline down through the skin and subcutaneous tissue. We split the Achilles tendon with a 15 blade mid portion. We then dissected it carefully off the calcaneus, both medially and laterally. There were large osteophytes in this area. We made sure we got far enough medial and lateral to get all the bone prominence. The bone prominences were removed with an osteotome and a mallet. We also used a rongeur to smooth the surfaces. We used C-arm fluoroscopy to confirm that we removed all the bony fragments. The undersurface of Achilles tendon was debrided with tenotomies and pickups. The tendon itself appeared in good condition. There was minimal tendinopathy. The wound was copiously irrigated. I drilled and impacted 2 Smith and Nephew Q-Fix anchors into the insertional Achilles tendon on the posterior aspect of the calcaneus. We used #2 Ultrabraid from the Q-Fix anchors to reattach the Achilles tendon to the bone. I used two of the suture limbs to reapproximate the Achilles tendon midline proximally. We then drilled and impacted the Smith and Nephew Footprint anchor distally. We passed 2 of the Q-Fix suture limbs into the Footprint anchor and then impacted to bone. We then took those 2 limbs and oversewed the plantar aspect of the fat pad back to the Achilles. The wounds were copiously irrigated. The tourniquet was let down after 32 minutes. The paratenon was reapproximated with 3-0 Monocryl suture. Subcutaneous tissue was closed with buried 3-0 Monocryl suture, the skin with 3-0 nylon.
Can the 28118 be coded or is there something more appropriate?
Thanks in advance!
OP NOTE:
Incision was made midline down through the skin and subcutaneous tissue. We split the Achilles tendon with a 15 blade mid portion. We then dissected it carefully off the calcaneus, both medially and laterally. There were large osteophytes in this area. We made sure we got far enough medial and lateral to get all the bone prominence. The bone prominences were removed with an osteotome and a mallet. We also used a rongeur to smooth the surfaces. We used C-arm fluoroscopy to confirm that we removed all the bony fragments. The undersurface of Achilles tendon was debrided with tenotomies and pickups. The tendon itself appeared in good condition. There was minimal tendinopathy. The wound was copiously irrigated. I drilled and impacted 2 Smith and Nephew Q-Fix anchors into the insertional Achilles tendon on the posterior aspect of the calcaneus. We used #2 Ultrabraid from the Q-Fix anchors to reattach the Achilles tendon to the bone. I used two of the suture limbs to reapproximate the Achilles tendon midline proximally. We then drilled and impacted the Smith and Nephew Footprint anchor distally. We passed 2 of the Q-Fix suture limbs into the Footprint anchor and then impacted to bone. We then took those 2 limbs and oversewed the plantar aspect of the fat pad back to the Achilles. The wounds were copiously irrigated. The tourniquet was let down after 32 minutes. The paratenon was reapproximated with 3-0 Monocryl suture. Subcutaneous tissue was closed with buried 3-0 Monocryl suture, the skin with 3-0 nylon.
Can the 28118 be coded or is there something more appropriate?
Thanks in advance!