Ravikirann
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Dear All,
Can i get the CPT codes from this OT notes.
INDICATIONS FOR PROCEDURE: The patient is a 59-year-old woman who presented with a symptomatic hallux valgus and a clawtoe deformity at her second toe. Examination revealed significant instability of her second MTP joint, consistent with a plantar plate rupture. After discussion of risks, benefits, and alternatives, she felt she had failed nonoperative management and wished to proceed with surgical treatment.
PROCEDURE IN DETAIL AND FINDINGS: The patient was brought to the operating room where a general anesthetic was administered and airway was secured without difficulty. Preoperative antibiotic prophylaxis was provided within an hour of the incision.
Prophylaxis was discontinued on the day of surgery. A tourniquet was placed on the right calf. The right leg and foot were prepped and draped in a sterile fashion. The limb was elevated for exsanguination and the tourniquet inflated. A pause for the cause was performed.
I began at the great toe. A medial incision was made. An elliptical capsulotomy was performed. Medial eminence was exposed. This was resected at the level of the sulcus with an oscillating saw and transected, a lateral released was performed. A long plantar limb chevron osteotomy was then performed and the capital fragment translated laterally through the capsular window. This was provisionally held with a clamp and then secured with two 2.4 mm screws. Position of this was appropriate. Sesamoids were well reduced. The persistent hallux valgus interphalangeus was noted. Therefore, I extended my incision slightly distally and performed a medially based closing wedge osteotomy at the proximal phalanx of the great toe. We placed two staples here, but there was still significant play in the osteotomy site and I was worried this would go on to a nonunion. Therefore, I did place an additional screw from distal medial to proximal lateral. This secured the osteotomy well. Position was good. There was slight extension on the lateral view, but this was not felt to be problematic and did not create any clinical deformity.
At this point, I moved to the second toe. A dorsal incision was made. The extensor tendon was mobilized. The capsule was split in line with the incision. A Weil osteotomy was performed. It was provisionally held with a pin. Second pin was placed into the base of the proximal phalanx. A retractor was placed and the joint exposed. There was a medial capsular tear. This was completed with a knife. I then placed horizontal mattress suture through the plantar plate using a small plantar incision. Drill holes were placed in the base of the proximal phalanx and the suture was brought up through the proximal phalanx. The pins were removed. The Weil osteotomy was positioned and fixed with a 2.0 mm screw. The joint was then held reduced and the plantar plate tied over the top of the proximal phalanx. Position was good. At this point, final AP, lateral, and oblique views were taken and reviewed. Alignment was good. Instrumentation was stable.
The wounds were then irrigated with sterile saline and closed in layers. The medial capsule at the first MTP joint was closed with interrupted PDS sutures.
Adaptic sterile dressings and a well-padded slipper cast were applied.
The patient tolerated the procedure well. There were no complications. All sponge and needle counts were correct.
PLAN: She will be on a standard bunion protocol. She will be in a cast nonweightbearing for two weeks. She will then return for cast off, wound check, sutures out, and placement of a Wedge Darco shoe.
She can then heel weightbear for an additional month. She will return at six weeks for AP, lateral, oblique, weightbearing views of the right foot and a re-examination.
Thanks
Raj
Can i get the CPT codes from this OT notes.
INDICATIONS FOR PROCEDURE: The patient is a 59-year-old woman who presented with a symptomatic hallux valgus and a clawtoe deformity at her second toe. Examination revealed significant instability of her second MTP joint, consistent with a plantar plate rupture. After discussion of risks, benefits, and alternatives, she felt she had failed nonoperative management and wished to proceed with surgical treatment.
PROCEDURE IN DETAIL AND FINDINGS: The patient was brought to the operating room where a general anesthetic was administered and airway was secured without difficulty. Preoperative antibiotic prophylaxis was provided within an hour of the incision.
Prophylaxis was discontinued on the day of surgery. A tourniquet was placed on the right calf. The right leg and foot were prepped and draped in a sterile fashion. The limb was elevated for exsanguination and the tourniquet inflated. A pause for the cause was performed.
I began at the great toe. A medial incision was made. An elliptical capsulotomy was performed. Medial eminence was exposed. This was resected at the level of the sulcus with an oscillating saw and transected, a lateral released was performed. A long plantar limb chevron osteotomy was then performed and the capital fragment translated laterally through the capsular window. This was provisionally held with a clamp and then secured with two 2.4 mm screws. Position of this was appropriate. Sesamoids were well reduced. The persistent hallux valgus interphalangeus was noted. Therefore, I extended my incision slightly distally and performed a medially based closing wedge osteotomy at the proximal phalanx of the great toe. We placed two staples here, but there was still significant play in the osteotomy site and I was worried this would go on to a nonunion. Therefore, I did place an additional screw from distal medial to proximal lateral. This secured the osteotomy well. Position was good. There was slight extension on the lateral view, but this was not felt to be problematic and did not create any clinical deformity.
At this point, I moved to the second toe. A dorsal incision was made. The extensor tendon was mobilized. The capsule was split in line with the incision. A Weil osteotomy was performed. It was provisionally held with a pin. Second pin was placed into the base of the proximal phalanx. A retractor was placed and the joint exposed. There was a medial capsular tear. This was completed with a knife. I then placed horizontal mattress suture through the plantar plate using a small plantar incision. Drill holes were placed in the base of the proximal phalanx and the suture was brought up through the proximal phalanx. The pins were removed. The Weil osteotomy was positioned and fixed with a 2.0 mm screw. The joint was then held reduced and the plantar plate tied over the top of the proximal phalanx. Position was good. At this point, final AP, lateral, and oblique views were taken and reviewed. Alignment was good. Instrumentation was stable.
The wounds were then irrigated with sterile saline and closed in layers. The medial capsule at the first MTP joint was closed with interrupted PDS sutures.
Adaptic sterile dressings and a well-padded slipper cast were applied.
The patient tolerated the procedure well. There were no complications. All sponge and needle counts were correct.
PLAN: She will be on a standard bunion protocol. She will be in a cast nonweightbearing for two weeks. She will then return for cast off, wound check, sutures out, and placement of a Wedge Darco shoe.
She can then heel weightbear for an additional month. She will return at six weeks for AP, lateral, oblique, weightbearing views of the right foot and a re-examination.
Thanks
Raj
