Hi list I am hoping someone can please take the time out to assist me with this note, I am still learning Podiatry coding and this is what I have coded so far.
28750-T5
28285-T6
28285-T7
28270-T6
I am not sure of what to code for the Dorsal exostectomy 1st tarsometatarsal joint of Rt foot???
Tia
MELJNBBRB,CCS,CPC
Pre-operative Diagnosis:
1. Hallux abducto valgus with osteoarthritis right 1st metatarsophalangeal joint
2. Hammertoe deformity 2nd and 3rd digits right foot
3. Dorsal exostosis 1st tarsometatarsal joint right foot
Post-operative Diagnosis:
Same as above
Procedure:
1. 1st MPJ fusion right foot with screw and plate fixation
2. Dorsal exostectomy 1st tarsometatarsal joint right foot
3. PIPJ fusion with implant 2nd digit right foot
4. PIPJ fusion with implant 3rd digit right foot
5. 2nd metatarsal phalangeal joint capsulotomy right foot
Findings: consistent with diagnosis
Estimated Blood Loss: Minimal
Drains: wright medical swanson drain
Total IV Fluids: per anesthesia
Specimens: none
Hemostasis:
A well padded tourniquet was placed about the right calf set at 250 mmHg
Injectables:
30 mL of 0.5% marcaine plain was infiltrated proximal to the incision site.
Implants:
(2) 10 x 3.5mm locking screws
(1) 12 x 3.5mm locking screw
(2) 16 x 3.5mm locking screws
(1) 14 x 3.5mm non-locking screw
(1) 32 x 3.0mm partially threaded cannulated compression screw
(1) Wright Medical Ortholoc 3Di small 1st MTP fusion plate
(1) Wright Medical 2.4 x 16mm ProToe
(1) Wright Medical 2.0 x 13mm ProToe
Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Attending Attestation: I performed the procedure.
Surgeon: DPM
Assistants: none
Anesthesia: General endotracheal anesthesia
Procedure Details
The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The risks and potential complications of their problem and purposed treatment include but are not limited to infection, nerve injury, vascular injury, nonunion of the syndesmosis, persistent pain, potential skin necrosis, deep vein thrombosis, possible pulmonary embolus, complications of the anesthetics and failure of the implant. The patient concurred with the proposed plan, giving informed consent. The site of surgery properly noted/marked. The patient was identified as Cxxxand the procedure verified. A Time Out was held and the above information confirmed.
The patient was brought to the operating room, placed in the supine position on the operative table.
After adequate induction of anesthesia, the tourniquet was placed, the patient?s right lower extremity was prepped and draped in the usual sterile fashion.
The right lower leg was elevated and the exsanguinated with an esmarch bandage.
The calf tourniquet was inflated and esmarch bandage was then released.
Procedure #1 - 1st MPJ fusion right foot with screw and plate fixation
Patient brought into the operating room and placed on the table in a supine position. Timeout performed with myself in the room verifying correct procedure, site, instrumentation present. A well-padded tourniquet was applied to the ankle. An Esmarch bandage was utilized to exsanguinate the limb after a sterile prep. Tourniquet was inflated to 250 mmHg.
A 8 cm slightly curvilinear incision was made over the dorsal aspect of the right first metatarsophalangeal joint ending dorsally over the 1st TMT joint at the site of the bony exostosis for procedure #3. It was deepened down with care to cauterize superficial vessels. Medial neurovascular bundle was identified, protected, and retracted. Linear capsular incision was made delivering first metatarsophalangeal joint into the surgical field. Significant scar tissue was noted about the 1st metatarsophalangeal joint from previous bunionectomy procedure which included a medial head resection of the 1st metatarsal. Once exposure of the base of the proximal phalanx and the head of the 1st metatarsal were performed, a combination of sagittal saw as well as reamers was utilized to create healthy bleeding bony tissues about the arthrodesis site in a cup and cone fashion. At this time a compression screw was thrown from distal medial to proximal lateral across the 1st metatarsophalangeal joint arthrodesis site. The screw measured 32 mm x 3.0 mm. The screw was partially threaded and cannulated. At this time, hardware in the form of a plate and screws was placed using standard technique. Wright medical Ortholoc 3di plate and screws were utilized. Excellent stability, compression and toe position was achieved with confirmation on FluoroScan. Please note that care was taken to fuse the hallux in a slightly dorsiflexed position approximately 10? in the sagittal plane with slight abduction / neutral position within the transverse plane and no frontal plane deviation. Intraoperative fluoroscopy was brought into the operative site for evaluation of the correction. The correction was found to be excellent.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 Vicryl suture.
The subcutaneous tissue was reapproximated with 4-0 monocryl suture.
The skin edges were reapproximated with 4-0 prolene suture.
Procedure #2 - Dorsal Exostectomy 1st TMT joint right foot
Attention was directed to the dorsal aspect of the right foot overlying the 1st TMT joint. The incision was carried proximally and a slightly curvilinear fashion directly dorsal to a prominent bony exostosis at the 1st tarsometatarsal joint.
The incision was carried deep utilizing a combination of sharp and blunt dissection taking care to avoid all major NV structures and tendon, taking care to clamp and bovie all bleeders when necessary.
An incision was made into the periosteum at this site.
The periosteum was reflected with a freer elevator. The exostosis was then resected with an osteotome and mallet and then rasped smooth with a reciprocating rasp.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Bone wax was applied to prevent bony regrowth.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 vicryl suture.
The subcutaneous tissue was reapproximated with 4-0 monocryl suture.
The skin edges were reapproximated with 4-0 prolene suture.
Procedure #3, 4, 5 - PIPJ fusion with implant 2nd and 3rd digits right foot
- Attention was directed to the dorsal aspect of the 2nd and 3rd toe of the right foot, where a 3cm linear incision was made.
- This incision was carried deep utilizing a combination of blunt and sharp dissection, carefully retracting aside all major neurovascular structures and tendons, taking care to clamp and bovie all bleeders when necessary.
- At the level of the proximal inter-phalangeal joint, a Z-lengthening tenotomy with capsulotomy was performed at the head of the proximal phalanx.
- The head of the proximal phalanx was freed from medial and lateral collateral ligaments, plantar soft tissue attachments, and dorsal extensor complex, which was reflected proximally and distally.
- The head of the proximal phalanx was then delivered into the surgical site.
- The joint had evidence of DJD and was resected using oscillating saw.
- The remaining shaft of the proximal phalanx was inspected for any bony spicules and none were found.
- The proximal phalanx was contoured with rongeur.
- Attention was then directed to the base of the intermediate phalanx where the cartilage was removed with an oscillating saw.
- (5th procedure) Attention was directed to the capsule of the 2nd metatarsal phalangeal joint, which was transected dorsally, medially, and laterally to correct the transverse plain deviation and/or dislocation.
- At this time placement of a Wright Medical Protoe was performed for the 2nd and 3rd digits. Using the appropriate instrumentation and insertion of a size 2.4 x 16 mm for the 2nd toe and a size 2.0 x 13 mm for the 3rd toe were inserted into the proximal phalanx and middle phalanx.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 vicryl suture.
The skin edges were reapproximated with 4-0 Prolene suture.
Postoperative bandage was applied to the right foot incision site consisting of Adaptec 4 X 4 gauze, Kling gauze, Kerlix gauze, and Coban self-adhering tape, and pneumatic Cam Walker
The Esmarch bandage was then released with immediate reactive hyperemia noted to the digits of the patient?s rightfoot.
The pneumatic thigh tourniquet was released with immediate reactive hyperemia noted to the digits of the patient?s right foot.
The patient tolerated the anesthesia and procedure well and left the operating room with vital signs stable and vascular status intact.
The patient was transported to the recovery room for continued monitoring until the criteria for discharge summery had been met.
The patient was given postoperative instructions and advised to follow up with xxxx in his office for all-postoperative care and management.
28750-T5
28285-T6
28285-T7
28270-T6
I am not sure of what to code for the Dorsal exostectomy 1st tarsometatarsal joint of Rt foot???
Tia
MELJNBBRB,CCS,CPC
Pre-operative Diagnosis:
1. Hallux abducto valgus with osteoarthritis right 1st metatarsophalangeal joint
2. Hammertoe deformity 2nd and 3rd digits right foot
3. Dorsal exostosis 1st tarsometatarsal joint right foot
Post-operative Diagnosis:
Same as above
Procedure:
1. 1st MPJ fusion right foot with screw and plate fixation
2. Dorsal exostectomy 1st tarsometatarsal joint right foot
3. PIPJ fusion with implant 2nd digit right foot
4. PIPJ fusion with implant 3rd digit right foot
5. 2nd metatarsal phalangeal joint capsulotomy right foot
Findings: consistent with diagnosis
Estimated Blood Loss: Minimal
Drains: wright medical swanson drain
Total IV Fluids: per anesthesia
Specimens: none
Hemostasis:
A well padded tourniquet was placed about the right calf set at 250 mmHg
Injectables:
30 mL of 0.5% marcaine plain was infiltrated proximal to the incision site.
Implants:
(2) 10 x 3.5mm locking screws
(1) 12 x 3.5mm locking screw
(2) 16 x 3.5mm locking screws
(1) 14 x 3.5mm non-locking screw
(1) 32 x 3.0mm partially threaded cannulated compression screw
(1) Wright Medical Ortholoc 3Di small 1st MTP fusion plate
(1) Wright Medical 2.4 x 16mm ProToe
(1) Wright Medical 2.0 x 13mm ProToe
Complications: None; patient tolerated the procedure well.
Disposition: PACU - hemodynamically stable.
Condition: stable
Attending Attestation: I performed the procedure.
Surgeon: DPM
Assistants: none
Anesthesia: General endotracheal anesthesia
Procedure Details
The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The risks and potential complications of their problem and purposed treatment include but are not limited to infection, nerve injury, vascular injury, nonunion of the syndesmosis, persistent pain, potential skin necrosis, deep vein thrombosis, possible pulmonary embolus, complications of the anesthetics and failure of the implant. The patient concurred with the proposed plan, giving informed consent. The site of surgery properly noted/marked. The patient was identified as Cxxxand the procedure verified. A Time Out was held and the above information confirmed.
The patient was brought to the operating room, placed in the supine position on the operative table.
After adequate induction of anesthesia, the tourniquet was placed, the patient?s right lower extremity was prepped and draped in the usual sterile fashion.
The right lower leg was elevated and the exsanguinated with an esmarch bandage.
The calf tourniquet was inflated and esmarch bandage was then released.
Procedure #1 - 1st MPJ fusion right foot with screw and plate fixation
Patient brought into the operating room and placed on the table in a supine position. Timeout performed with myself in the room verifying correct procedure, site, instrumentation present. A well-padded tourniquet was applied to the ankle. An Esmarch bandage was utilized to exsanguinate the limb after a sterile prep. Tourniquet was inflated to 250 mmHg.
A 8 cm slightly curvilinear incision was made over the dorsal aspect of the right first metatarsophalangeal joint ending dorsally over the 1st TMT joint at the site of the bony exostosis for procedure #3. It was deepened down with care to cauterize superficial vessels. Medial neurovascular bundle was identified, protected, and retracted. Linear capsular incision was made delivering first metatarsophalangeal joint into the surgical field. Significant scar tissue was noted about the 1st metatarsophalangeal joint from previous bunionectomy procedure which included a medial head resection of the 1st metatarsal. Once exposure of the base of the proximal phalanx and the head of the 1st metatarsal were performed, a combination of sagittal saw as well as reamers was utilized to create healthy bleeding bony tissues about the arthrodesis site in a cup and cone fashion. At this time a compression screw was thrown from distal medial to proximal lateral across the 1st metatarsophalangeal joint arthrodesis site. The screw measured 32 mm x 3.0 mm. The screw was partially threaded and cannulated. At this time, hardware in the form of a plate and screws was placed using standard technique. Wright medical Ortholoc 3di plate and screws were utilized. Excellent stability, compression and toe position was achieved with confirmation on FluoroScan. Please note that care was taken to fuse the hallux in a slightly dorsiflexed position approximately 10? in the sagittal plane with slight abduction / neutral position within the transverse plane and no frontal plane deviation. Intraoperative fluoroscopy was brought into the operative site for evaluation of the correction. The correction was found to be excellent.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 Vicryl suture.
The subcutaneous tissue was reapproximated with 4-0 monocryl suture.
The skin edges were reapproximated with 4-0 prolene suture.
Procedure #2 - Dorsal Exostectomy 1st TMT joint right foot
Attention was directed to the dorsal aspect of the right foot overlying the 1st TMT joint. The incision was carried proximally and a slightly curvilinear fashion directly dorsal to a prominent bony exostosis at the 1st tarsometatarsal joint.
The incision was carried deep utilizing a combination of sharp and blunt dissection taking care to avoid all major NV structures and tendon, taking care to clamp and bovie all bleeders when necessary.
An incision was made into the periosteum at this site.
The periosteum was reflected with a freer elevator. The exostosis was then resected with an osteotome and mallet and then rasped smooth with a reciprocating rasp.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Bone wax was applied to prevent bony regrowth.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 vicryl suture.
The subcutaneous tissue was reapproximated with 4-0 monocryl suture.
The skin edges were reapproximated with 4-0 prolene suture.
Procedure #3, 4, 5 - PIPJ fusion with implant 2nd and 3rd digits right foot
- Attention was directed to the dorsal aspect of the 2nd and 3rd toe of the right foot, where a 3cm linear incision was made.
- This incision was carried deep utilizing a combination of blunt and sharp dissection, carefully retracting aside all major neurovascular structures and tendons, taking care to clamp and bovie all bleeders when necessary.
- At the level of the proximal inter-phalangeal joint, a Z-lengthening tenotomy with capsulotomy was performed at the head of the proximal phalanx.
- The head of the proximal phalanx was freed from medial and lateral collateral ligaments, plantar soft tissue attachments, and dorsal extensor complex, which was reflected proximally and distally.
- The head of the proximal phalanx was then delivered into the surgical site.
- The joint had evidence of DJD and was resected using oscillating saw.
- The remaining shaft of the proximal phalanx was inspected for any bony spicules and none were found.
- The proximal phalanx was contoured with rongeur.
- Attention was then directed to the base of the intermediate phalanx where the cartilage was removed with an oscillating saw.
- (5th procedure) Attention was directed to the capsule of the 2nd metatarsal phalangeal joint, which was transected dorsally, medially, and laterally to correct the transverse plain deviation and/or dislocation.
- At this time placement of a Wright Medical Protoe was performed for the 2nd and 3rd digits. Using the appropriate instrumentation and insertion of a size 2.4 x 16 mm for the 2nd toe and a size 2.0 x 13 mm for the 3rd toe were inserted into the proximal phalanx and middle phalanx.
The wound was flushed with copious amounts of normal physiologic sterile saline and inspected for any soft tissue or osseous debris, none of which was found.
Intra-operative fluoroscopy was prepped and draped and brought into the operative site, for evaluation of the correction.
The correction was found to be adequate.
The capsule/periosteum was reapproximated with 4-0 vicryl suture.
The skin edges were reapproximated with 4-0 Prolene suture.
Postoperative bandage was applied to the right foot incision site consisting of Adaptec 4 X 4 gauze, Kling gauze, Kerlix gauze, and Coban self-adhering tape, and pneumatic Cam Walker
The Esmarch bandage was then released with immediate reactive hyperemia noted to the digits of the patient?s rightfoot.
The pneumatic thigh tourniquet was released with immediate reactive hyperemia noted to the digits of the patient?s right foot.
The patient tolerated the anesthesia and procedure well and left the operating room with vital signs stable and vascular status intact.
The patient was transported to the recovery room for continued monitoring until the criteria for discharge summery had been met.
The patient was given postoperative instructions and advised to follow up with xxxx in his office for all-postoperative care and management.
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