SavCoder
Contributor
Provider is suggesting:
27634 for removal of ganglion cyst from the left leg proximal tibia fibular joint
And 64708 for the nerve decompression
But in the op note it describes the stalk of the cyst tracing to the joint and the provider performing an arthrotomy to try and prevent recurrence of the cyst. Should this be an unlisted CPT 27899 due to the cyst going to the joint and arthrotomy performed?
Preop Dx:
1. Ganglion cyst of left proximal tibia fibular joint with compression of the peroneal nerve
Postop Dx:
1. Ganglion cyst of left proximal tibia fibular joint with compression of the peroneal nerve
Procedure(s):
1. Removal of ganglion cyst from left leg proximal tibia fibular joint
2. Exploration decompression of peroneal nerve left leg
Findings:
Ganglion cyst wrapped around the peroneal nerve
Complications:
None
Procedure Description:
After elevation for several minutes and tourniquet on the left leg was elevated. A curvilinear incision was then made centered over the proximal tibia fibular joint. Sharp dissection was carried down to subcutaneous tissue and hemostasis was achieved with electrocautery. Full-thickness skin flaps were elevated. The deep fascia of the leg was carefully opened and the biceps tendon was identified proximally. Just posterior to this the peroneal nerve was identified. Careful dissection using Metzenbaum scissors allowed gradual mobilization of the peroneal nerve. This was protected with a Penrose drain throughout the remainder of the case. Dissection was carried in a proximal to distal fashion and at the level of the proximal tibia fibular joint the nerve was noted to be wrapped in the ganglion cyst. Dissection was then carried over the top of the ganglion cyst in down into the anterior compartment. The fascia of the anterior compartment was opened and the muscle was carefully split to allow for visualization of the nerve distal to the ganglion cyst. Dissection was then carried down onto the anterior intermuscular septum and this was partially freed up to allow complete decompression of the peroneal nerve. With the nerve protected on both sides of the cyst was carefully dissected away from the ganglion cyst. The cyst was then carefully mobilized and traced back to its origin at the proximal tibia fibular joint. The stalk of the cyst was then transected in this area and a small arthrotomy was made try to prevent recurrence of the cyst. Cyst was then sent off for pathology.
The wound was then thoroughly irrigated with sterile saline. Tourniquet was then deflated. Hemostasis was achieved electrocautery. A deep suction drain was then placed in the wound was closed in layers using 0 Vicryl suture for the deep fascia. Subcutaneous tissue was closed with 2 O Vicryl and the skin was closed with 3 Monocryl. The wound was then washed and dressed with a skin sealant, Adaptic, sterile 4x4s a light compressive dressing. The patient was then awakened from anesthesia in stable and satisfactory condition and transferred to the recovery room. Plan postoperatively is for admission to the orthopedic floor with removal of her drain in the morning discharge home in the morning.
Any thoughts is greatly appreciated!
Thank you
27634 for removal of ganglion cyst from the left leg proximal tibia fibular joint
And 64708 for the nerve decompression
But in the op note it describes the stalk of the cyst tracing to the joint and the provider performing an arthrotomy to try and prevent recurrence of the cyst. Should this be an unlisted CPT 27899 due to the cyst going to the joint and arthrotomy performed?
Preop Dx:
1. Ganglion cyst of left proximal tibia fibular joint with compression of the peroneal nerve
Postop Dx:
1. Ganglion cyst of left proximal tibia fibular joint with compression of the peroneal nerve
Procedure(s):
1. Removal of ganglion cyst from left leg proximal tibia fibular joint
2. Exploration decompression of peroneal nerve left leg
Findings:
Ganglion cyst wrapped around the peroneal nerve
Complications:
None
Procedure Description:
After elevation for several minutes and tourniquet on the left leg was elevated. A curvilinear incision was then made centered over the proximal tibia fibular joint. Sharp dissection was carried down to subcutaneous tissue and hemostasis was achieved with electrocautery. Full-thickness skin flaps were elevated. The deep fascia of the leg was carefully opened and the biceps tendon was identified proximally. Just posterior to this the peroneal nerve was identified. Careful dissection using Metzenbaum scissors allowed gradual mobilization of the peroneal nerve. This was protected with a Penrose drain throughout the remainder of the case. Dissection was carried in a proximal to distal fashion and at the level of the proximal tibia fibular joint the nerve was noted to be wrapped in the ganglion cyst. Dissection was then carried over the top of the ganglion cyst in down into the anterior compartment. The fascia of the anterior compartment was opened and the muscle was carefully split to allow for visualization of the nerve distal to the ganglion cyst. Dissection was then carried down onto the anterior intermuscular septum and this was partially freed up to allow complete decompression of the peroneal nerve. With the nerve protected on both sides of the cyst was carefully dissected away from the ganglion cyst. The cyst was then carefully mobilized and traced back to its origin at the proximal tibia fibular joint. The stalk of the cyst was then transected in this area and a small arthrotomy was made try to prevent recurrence of the cyst. Cyst was then sent off for pathology.
The wound was then thoroughly irrigated with sterile saline. Tourniquet was then deflated. Hemostasis was achieved electrocautery. A deep suction drain was then placed in the wound was closed in layers using 0 Vicryl suture for the deep fascia. Subcutaneous tissue was closed with 2 O Vicryl and the skin was closed with 3 Monocryl. The wound was then washed and dressed with a skin sealant, Adaptic, sterile 4x4s a light compressive dressing. The patient was then awakened from anesthesia in stable and satisfactory condition and transferred to the recovery room. Plan postoperatively is for admission to the orthopedic floor with removal of her drain in the morning discharge home in the morning.
Any thoughts is greatly appreciated!
Thank you