mray906
Networker
Can someone take a look at this op report and tell me if I am thinking correctly. I am thinking it would be a double osteotomy 28299
The doc is saying to bill 28306 and 28310
Any help would be greatly appreciated.
PREOPERATIVE DIAGNOSIS(ES):
1. Hallux abductovalgus deformity, right foot.
2. Deformed hallux, right foot.
POSTOPERATIVE DIAGNOSIS(ES):
1. Hallux abductovalgus deformity, right foot.
2. Deformed hallux, right foot.
OPERATION:
1. Bunionectomy with 1st metatarsal osteotomy, right foot.
2. Hallux proximal phalanx osteotomy, right foot.
PATHOLOGY: Bone, right foot.
HEMOSTASIS: Pneumatic ankle tourniquet at 250 mmHg.
ESTIMATED BLOOD LOSS: 5 mL.
MATERIALS: Wright Medical 2.0 mm cannulated screws x3.
INJECTABLES: 20 mL of 0.5% Marcaine plain mixed with 1% lidocaine plain and a 1:1 mixture was injected preoperatively.
COMPLICATIONS: None apparent.
OPERATION IN DETAIL: Patient was consented for the procedure and brought outside the OR where the name and allergy bands were rechecked. The patient was brought into the OR and positioned on the table in supine position. After adequate anesthesia was administered, the patient`s right lower extremity was prepped and draped in usual sterile fashion. At this time, the tourniquet was inflated and attention was directed to the dorsum of the right foot where an incision was made along the extensor hallucis longus tendon and overlying the 1st metatarsal and proximal phalanx. Incision was deepened through skin and subcutaneous tissues, where the extensor hallucis longus tendon was identified and retracted laterally. A lateral release was performed at the level of the first metatarsophalangeal joint and release of the fibular sesamoid ligament as well as the adductor hallucis tendon was performed. Capsular and periosteal tissues were then reflected off the distal 1st metatarsal and proximal phalanx. A distal metatarsal osteotomy was performed of the first metatarsal with a microsagittal saw. Capital fragment was trans weighted laterally and provisionally fixated with a K-wire. Guidewires for the 2.0 mm cannulated screw set were then inserted from dorsal to plantar. Plantar cortical purchase was noted. 2.0 mm cannulated screws were then inserted over the guidewires and good bony purchase was appreciated. Guidewires were then removed. The overhanging cortical bone was then resected after translation of the capital fragment.
An oblique medial based wedge osteotomy was then performed of the hallux proximal phalanx. Once the wedge was removed, the osteotomy was closed and fixated with a 2.0 mm cannulated screw. Good rectus position of the toe was noted at this time. The surgical site was then copiously irrigated with normal sterile saline. Capsular closure was performed with 2-0 Vicryl suture, followed by deep dermal and skin closure with absorbable suture. Dermabond and Steri-Strips were then applied to the surgical wound. Postoperative compressive dressing was applied to the right lower extremity. The patient tolerated the procedure and anesthesia well. Patient was transferred from the OR to the recovery room with vital signs stable and vascular status intact to the right foot. No complications were noted. Dr. Karl Saltrick was present and scrubbed for all key and critical portions of surgical procedure, and was immediately available at all times
The doc is saying to bill 28306 and 28310
Any help would be greatly appreciated.
PREOPERATIVE DIAGNOSIS(ES):
1. Hallux abductovalgus deformity, right foot.
2. Deformed hallux, right foot.
POSTOPERATIVE DIAGNOSIS(ES):
1. Hallux abductovalgus deformity, right foot.
2. Deformed hallux, right foot.
OPERATION:
1. Bunionectomy with 1st metatarsal osteotomy, right foot.
2. Hallux proximal phalanx osteotomy, right foot.
PATHOLOGY: Bone, right foot.
HEMOSTASIS: Pneumatic ankle tourniquet at 250 mmHg.
ESTIMATED BLOOD LOSS: 5 mL.
MATERIALS: Wright Medical 2.0 mm cannulated screws x3.
INJECTABLES: 20 mL of 0.5% Marcaine plain mixed with 1% lidocaine plain and a 1:1 mixture was injected preoperatively.
COMPLICATIONS: None apparent.
OPERATION IN DETAIL: Patient was consented for the procedure and brought outside the OR where the name and allergy bands were rechecked. The patient was brought into the OR and positioned on the table in supine position. After adequate anesthesia was administered, the patient`s right lower extremity was prepped and draped in usual sterile fashion. At this time, the tourniquet was inflated and attention was directed to the dorsum of the right foot where an incision was made along the extensor hallucis longus tendon and overlying the 1st metatarsal and proximal phalanx. Incision was deepened through skin and subcutaneous tissues, where the extensor hallucis longus tendon was identified and retracted laterally. A lateral release was performed at the level of the first metatarsophalangeal joint and release of the fibular sesamoid ligament as well as the adductor hallucis tendon was performed. Capsular and periosteal tissues were then reflected off the distal 1st metatarsal and proximal phalanx. A distal metatarsal osteotomy was performed of the first metatarsal with a microsagittal saw. Capital fragment was trans weighted laterally and provisionally fixated with a K-wire. Guidewires for the 2.0 mm cannulated screw set were then inserted from dorsal to plantar. Plantar cortical purchase was noted. 2.0 mm cannulated screws were then inserted over the guidewires and good bony purchase was appreciated. Guidewires were then removed. The overhanging cortical bone was then resected after translation of the capital fragment.
An oblique medial based wedge osteotomy was then performed of the hallux proximal phalanx. Once the wedge was removed, the osteotomy was closed and fixated with a 2.0 mm cannulated screw. Good rectus position of the toe was noted at this time. The surgical site was then copiously irrigated with normal sterile saline. Capsular closure was performed with 2-0 Vicryl suture, followed by deep dermal and skin closure with absorbable suture. Dermabond and Steri-Strips were then applied to the surgical wound. Postoperative compressive dressing was applied to the right lower extremity. The patient tolerated the procedure and anesthesia well. Patient was transferred from the OR to the recovery room with vital signs stable and vascular status intact to the right foot. No complications were noted. Dr. Karl Saltrick was present and scrubbed for all key and critical portions of surgical procedure, and was immediately available at all times