alicia
New
Diagnosis: Dislocated thrid metatarsophalangeal joint
Procedure: Third metatarsophalangeal joint replacement
Currently the only thing I am finding is an unlisted code. The phyisican coded 28308 - Osteotomy, other than first metatarsal. Not sure this is correct.
Any thoughts? Procedure note below. Thanks!!
Description of Procedure" The operative site was identified as the left foot. She was taken from the preoperative holding area and placed on the operating table in the normalsupine position. After adequate IV sedation, she was anesthetized using 10 mLof 2% lidocaine plain to the left third MPJ. The tourniquet was placed around the left ankle. She was prepped and draped in the normal sterile fashion. The leg was elevated, exsanguinated. The tourniquet was raised to 250 mmHg. Attention was directed to the dorsal aspect of the left third MPJ where longitudinal incision was made through the skin down to the subcutaneous tissues. Blunt dissection was used to dissect through the subcutaneous tissues carefully retracting all neurovascular structures out of the surgical site and bovieing all small bleeders. The capsule of the first MPJ was incised in the same plane as the skin incision. Sharp dissection was used to raise the capsular flap off the head of the first metatarsal and base of the proximal phalanx. Canals were drilled using the interflex provided drill. The 10 mm trial was placed in and trimmed. Good range of motion and placement had been achieved. The real implant was placed in after trimming the stem. There was good range of motion.
The wound was flushed with adequate amounts of normal sterile saline and closed
in a normal layered fashion using 3-0 Vicryl for the capsular layer, 4-0
chromic gut for the subcutaneous and 4-0 Prolene for the skin. Then 8 mL of
0.5% Marcaine plain was injected around the surgical site for postoperative
anesthesia. The wound was dressed with Adaptic, 4x4s, Kling and an Ace.
Procedure: Third metatarsophalangeal joint replacement
Currently the only thing I am finding is an unlisted code. The phyisican coded 28308 - Osteotomy, other than first metatarsal. Not sure this is correct.
Any thoughts? Procedure note below. Thanks!!
Description of Procedure" The operative site was identified as the left foot. She was taken from the preoperative holding area and placed on the operating table in the normalsupine position. After adequate IV sedation, she was anesthetized using 10 mLof 2% lidocaine plain to the left third MPJ. The tourniquet was placed around the left ankle. She was prepped and draped in the normal sterile fashion. The leg was elevated, exsanguinated. The tourniquet was raised to 250 mmHg. Attention was directed to the dorsal aspect of the left third MPJ where longitudinal incision was made through the skin down to the subcutaneous tissues. Blunt dissection was used to dissect through the subcutaneous tissues carefully retracting all neurovascular structures out of the surgical site and bovieing all small bleeders. The capsule of the first MPJ was incised in the same plane as the skin incision. Sharp dissection was used to raise the capsular flap off the head of the first metatarsal and base of the proximal phalanx. Canals were drilled using the interflex provided drill. The 10 mm trial was placed in and trimmed. Good range of motion and placement had been achieved. The real implant was placed in after trimming the stem. There was good range of motion.
The wound was flushed with adequate amounts of normal sterile saline and closed
in a normal layered fashion using 3-0 Vicryl for the capsular layer, 4-0
chromic gut for the subcutaneous and 4-0 Prolene for the skin. Then 8 mL of
0.5% Marcaine plain was injected around the surgical site for postoperative
anesthesia. The wound was dressed with Adaptic, 4x4s, Kling and an Ace.