Post Op: Inflamed bursa, right first metatarsophalangeal joint
(path dx: mild chronic inflamed bursa)
Procedure: Excision of bursa, right first metatarsophalangeal joint
Description:
A skin skribe was used to delineate a 3 cm long incision along the medial aspect of the first metatarsophalangeal joint. The incision was carried deep to the level of the soft tissue structure, which was clearly extracapsular in its nature. Some gouty tophus was found around a large nodular structure that clearly coincided with both the ultrasound and preoperative MRI. The structure was removed from its attachment to the subcutaneous tissues and found to be quite mobile. It was also attached very intermittently with the plantar medial aspect of the metatarsophalangeal joint capsule. No additional gouty tophus was encountered with debridement and did not appear to be any additional tophi to the surrounding tissues. The mass was removed in toto and removed from the field. It was sent for pathology. The area was flushed with copious amounts of saline with additional insepection and no additional foreign objects were found. The skin was then closed with interrupted horizontal mattress sutures utilizing 4-0 nylon.
I was looking at 28022 at first, but now I am second guessing myself. Any help on this one is greatly appreciated. Thank you!!
(path dx: mild chronic inflamed bursa)
Procedure: Excision of bursa, right first metatarsophalangeal joint
Description:
A skin skribe was used to delineate a 3 cm long incision along the medial aspect of the first metatarsophalangeal joint. The incision was carried deep to the level of the soft tissue structure, which was clearly extracapsular in its nature. Some gouty tophus was found around a large nodular structure that clearly coincided with both the ultrasound and preoperative MRI. The structure was removed from its attachment to the subcutaneous tissues and found to be quite mobile. It was also attached very intermittently with the plantar medial aspect of the metatarsophalangeal joint capsule. No additional gouty tophus was encountered with debridement and did not appear to be any additional tophi to the surrounding tissues. The mass was removed in toto and removed from the field. It was sent for pathology. The area was flushed with copious amounts of saline with additional insepection and no additional foreign objects were found. The skin was then closed with interrupted horizontal mattress sutures utilizing 4-0 nylon.
I was looking at 28022 at first, but now I am second guessing myself. Any help on this one is greatly appreciated. Thank you!!
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