sgiles11
New
Trying to figure out the correct coding for a Lapiplasty with additional procedure. Posted this in Orth section, but it is probably better suited under Podiatry. What is the correct codes for the procedures documented?
Documentation states:
PROCEDURE IN DETAIL: On 12/28/2022 was identified in the preoperative holding area. His right foot was marked by members of surgical team. His consent was reviewed with him and no guarantee or stated. Patient wished to proceed with his right foot surgical procedure. He was taken to the OR placed on the OR table in supine position. Monitored anesthesia was administered. His right foot was exsanguinated and the right pneumatic ankle tourniquet was inflated to 250 mmHg. Approximately 20 cc of a 11 mix of 0.5% Marcaine plain and 1% lidocaine plain was injected in a Mayo block fashion as well as a V block fashion over the second metatarsophalangeal joint and a V block fashion over his fifth metatarsophalangeal joint. Attention was first directed to the dorsomedial aspect of his foot approximately 3 cm from his proximal to his medial cuneiform and the excision was extended to the dorsal aspect of his proximal phalanx through skin and superficial fascia. All vessels transverse incision site were properly ligated utilizing electrocautery Bovie. The first metatarsal cuneiform joint was visualized and there was arthritis also appreciated in the intercuneiform joints. The first metatarso-cuneiform joint was prepped utilizing AO technique and the Lapiplasty surgical system was utilized to correct the intermetatarsal angle at the base of the first metatarsal cuneiform joint. Fluoroscopy was taken and I was pleased with the correction of the intermetatarsal angle. A 0.045 K wire was placed from the dorsal medial aspect of the first metatarsal into the medial cuneiform and a second hallux. Was placed along the lateral plantar redirected medial dorsal medial cuneiform. I was pleased with the compression. 2 plates from the lapiplasty set were then placed utilizing AO technique. The intercuneiform joint was prepped and a interfrag screw was then placed from the medial cuneiform into the intermediate cuneiform fusion was appreciated by fluoroscopy. The wound was flushed with copious amount of saline. Attention was then directed to the head of the first metatarsal where the osseous medial. Bone spur was resected utilizing a sagittal the deep fascia periosteum was closed utilizing 3. 0 Monocryl. A capsulorrhaphy was performed and closed utilizing 3. 0 Monocryl. 4 screws taken out as pleased with the anterior cuneiform joint fusion as well as the first metatarsal cuneiform fusion period.the skin was reapproximated utilizing a subcuticular stitch of 3. Monocryl. And the skin was reprepped and closed utilizing a running subcutaneous stitch of 3. 0 Monocryl.
Attention was then directed to the second toe proximal interphalangeal joint where he transverse incision was made at the level of the proximal interphalangeal joint through skin and superficial fascia. The extensor digitorum longus tendon was identified and a transverse incision was made through the EDL tendon exposing the head of the proximal phalanx which was resected. The articular cartilage was removed off of the base of the middle phalanx. A 0.062 K wire was run through the middle and distal phalanx and then through an anterograde fashion into the proximal phalanx into the second metatarsal crossing the second metatarsophalangeal joint. The wound was flushed with copious amount of sterile saline. The EDL tendon was repaired utilizing 3. 0 Monocryl. The skin was reapproximated and closed utilizing 3. 0 Monocryl. Attention was then directed to the dorsal lateral fifth metatarsophalangeal joint where an incision was made through skin down to the superficial branch. All vessels transverse incision site were probably ligated utilizing electrocautery Bovie. This incision was deepened through the fascia periosteum exposing the head of the fifth metatarsal. The lateral fifth metatarsal head bone spur was resected utilizing sagittal saw. Fluoroscopy was taken and I was pleased with the amount of bone that was resected. The deep fascia periosteum was closed utilizing 3. 0 Monocryl in the superficial fascia was closed utilizing subcutaneous to close stitch of 3. 0 Monocryl and the skin was reapproximated closed utilizing 3. 0 Monocryl.
Documentation states:
PROCEDURE IN DETAIL: On 12/28/2022 was identified in the preoperative holding area. His right foot was marked by members of surgical team. His consent was reviewed with him and no guarantee or stated. Patient wished to proceed with his right foot surgical procedure. He was taken to the OR placed on the OR table in supine position. Monitored anesthesia was administered. His right foot was exsanguinated and the right pneumatic ankle tourniquet was inflated to 250 mmHg. Approximately 20 cc of a 11 mix of 0.5% Marcaine plain and 1% lidocaine plain was injected in a Mayo block fashion as well as a V block fashion over the second metatarsophalangeal joint and a V block fashion over his fifth metatarsophalangeal joint. Attention was first directed to the dorsomedial aspect of his foot approximately 3 cm from his proximal to his medial cuneiform and the excision was extended to the dorsal aspect of his proximal phalanx through skin and superficial fascia. All vessels transverse incision site were properly ligated utilizing electrocautery Bovie. The first metatarsal cuneiform joint was visualized and there was arthritis also appreciated in the intercuneiform joints. The first metatarso-cuneiform joint was prepped utilizing AO technique and the Lapiplasty surgical system was utilized to correct the intermetatarsal angle at the base of the first metatarsal cuneiform joint. Fluoroscopy was taken and I was pleased with the correction of the intermetatarsal angle. A 0.045 K wire was placed from the dorsal medial aspect of the first metatarsal into the medial cuneiform and a second hallux. Was placed along the lateral plantar redirected medial dorsal medial cuneiform. I was pleased with the compression. 2 plates from the lapiplasty set were then placed utilizing AO technique. The intercuneiform joint was prepped and a interfrag screw was then placed from the medial cuneiform into the intermediate cuneiform fusion was appreciated by fluoroscopy. The wound was flushed with copious amount of saline. Attention was then directed to the head of the first metatarsal where the osseous medial. Bone spur was resected utilizing a sagittal the deep fascia periosteum was closed utilizing 3. 0 Monocryl. A capsulorrhaphy was performed and closed utilizing 3. 0 Monocryl. 4 screws taken out as pleased with the anterior cuneiform joint fusion as well as the first metatarsal cuneiform fusion period.the skin was reapproximated utilizing a subcuticular stitch of 3. Monocryl. And the skin was reprepped and closed utilizing a running subcutaneous stitch of 3. 0 Monocryl.
Attention was then directed to the second toe proximal interphalangeal joint where he transverse incision was made at the level of the proximal interphalangeal joint through skin and superficial fascia. The extensor digitorum longus tendon was identified and a transverse incision was made through the EDL tendon exposing the head of the proximal phalanx which was resected. The articular cartilage was removed off of the base of the middle phalanx. A 0.062 K wire was run through the middle and distal phalanx and then through an anterograde fashion into the proximal phalanx into the second metatarsal crossing the second metatarsophalangeal joint. The wound was flushed with copious amount of sterile saline. The EDL tendon was repaired utilizing 3. 0 Monocryl. The skin was reapproximated and closed utilizing 3. 0 Monocryl. Attention was then directed to the dorsal lateral fifth metatarsophalangeal joint where an incision was made through skin down to the superficial branch. All vessels transverse incision site were probably ligated utilizing electrocautery Bovie. This incision was deepened through the fascia periosteum exposing the head of the fifth metatarsal. The lateral fifth metatarsal head bone spur was resected utilizing sagittal saw. Fluoroscopy was taken and I was pleased with the amount of bone that was resected. The deep fascia periosteum was closed utilizing 3. 0 Monocryl in the superficial fascia was closed utilizing subcutaneous to close stitch of 3. 0 Monocryl and the skin was reapproximated closed utilizing 3. 0 Monocryl.
