mray906
Networker
Hello Can someone look at this op report and see if I am thinking correctly?
I want to code a 1st MPJ arthrodesis (28750) and a Chielectomy (28298) and also bone marrow aspirated (38220)
The way it reads it appears that both procedures were done but then again I am not sure if they can be billed together.
PREOPERATIVE DIAGNOSIS(ES): Hallux rigidus, right foot.
POSTOPERATIVE DIAGNOSIS(ES): Hallux rigidus, right foot.
OPERATION:
1. Right first metatarsophalangeal joint arthrodesis.
2. Right foot harvest of bone graft.
HEMOSTASIS: Ankle tourniquet at 250 mmHg for 42 minutes.
ESTIMATED BLOOD LOSS: 5 cc.
MATERIALS: Wright Medical 0-degree first MTP plate x1, 3.0 cannulated screw x1, 2.7 locking screws x3, 3.5 locking screws x2,and 3.5 nonlocking screw x1. Vitoss bone graft, 1.5 cc.
INJECTABLES: None.
COMPLICATIONS: None.
FINDINGS: Consistent with diagnosis.
INDICATIONS FOR PROCEDURE: Hallux rigidus, right foot, first MPJ.
OPERATION IN DETAIL: The patient was consented for the procedure and brought outside the OR where the name and allergy bands were rechecked. The patient was positioned on the table in the supine position. After adequate anesthesia was administered, the patient`s right lower extremity was prepped and draped in a sterile fashion. At this time, attention was directed to the lateral aspect of the right calcaneus where a small stab incision was made with a #15 blade. Blunt dissection was carried down to the calcaneus, and then the Vitoss bone marrow harvest system was used to harvest approximately 5 mL of calcaneal bone marrow. The trephine was removed, and the entire incision was flushed with copious amounts of sterile normal saline followed by skin closure with 4-0 nylon.
A linear incision was then made over the first MPJ with a #15 blade. The dissection was carried down to expose the joint capsule. Vital neurovascular structures, including the EHL tendon, were identified and retracted. A capsular incision was then made, and the head of the first metatarsal, as well as the base of the proximal phalanx were exposed and isolated. Large osteophytes were removed off the first metatarsal head and the base of the proximal phalanx with a rongeur. The medial eminence and large dorsal osteophyte were then resected with an oscillating saw. Wright Medical reaming system was then used to remove all cartilage off the head of the first metatarsal and the base of the proximal phalanx. Any remaining cartilage was removed with a curette, and then the subchondral bone of both the first metatarsal head and the base of the proximal phalanx was then perforated with a 2-0 drill bit to expose healthy medullary contents.
Vitoss bone graft was then combined with the bone marrow aspirate, and this slurry was then inserted into the arthrodesis site and packed into any remaining gaps. A 3.0 cannulated Wright Medical screw was then inserted through the arthrodesis site, and reduction of the deformity, as well as fixation of the arthrodesis, was noted at this time. A Wright Medical 0-degree first MTP plate was then placed dorsally on the arthrodesis site, and the screws listed in the materials section were inserted in the standard fashion. Position of the hallux was verified clinically, and the entire incision was then flushed with copious amounts of sterile normal saline. Any remaining defects medially and laterally, as well as underneath the plate, were packed with the remaining Vitoss graft. Capsular closure was then performed with 2-0 Vicryl. Skin closure was then performed with 4-0 V-Loc . This linear incision was then sealed with DermaFlex and Steri-Strips. The medial stab incision for the cannulated screw was then closed with 4-0 nylon. All 3 incisions were then dressed with Xeroform, sterile 4 x 4s, Webril, and Ace wraps.
The patient tolerated the procedure and anesthesia well. The patient left the OR to recovery room with vital signs stable and vascular status intact to the right lower extremity. No complications were noted throughout the procedure
I want to code a 1st MPJ arthrodesis (28750) and a Chielectomy (28298) and also bone marrow aspirated (38220)
The way it reads it appears that both procedures were done but then again I am not sure if they can be billed together.
PREOPERATIVE DIAGNOSIS(ES): Hallux rigidus, right foot.
POSTOPERATIVE DIAGNOSIS(ES): Hallux rigidus, right foot.
OPERATION:
1. Right first metatarsophalangeal joint arthrodesis.
2. Right foot harvest of bone graft.
HEMOSTASIS: Ankle tourniquet at 250 mmHg for 42 minutes.
ESTIMATED BLOOD LOSS: 5 cc.
MATERIALS: Wright Medical 0-degree first MTP plate x1, 3.0 cannulated screw x1, 2.7 locking screws x3, 3.5 locking screws x2,and 3.5 nonlocking screw x1. Vitoss bone graft, 1.5 cc.
INJECTABLES: None.
COMPLICATIONS: None.
FINDINGS: Consistent with diagnosis.
INDICATIONS FOR PROCEDURE: Hallux rigidus, right foot, first MPJ.
OPERATION IN DETAIL: The patient was consented for the procedure and brought outside the OR where the name and allergy bands were rechecked. The patient was positioned on the table in the supine position. After adequate anesthesia was administered, the patient`s right lower extremity was prepped and draped in a sterile fashion. At this time, attention was directed to the lateral aspect of the right calcaneus where a small stab incision was made with a #15 blade. Blunt dissection was carried down to the calcaneus, and then the Vitoss bone marrow harvest system was used to harvest approximately 5 mL of calcaneal bone marrow. The trephine was removed, and the entire incision was flushed with copious amounts of sterile normal saline followed by skin closure with 4-0 nylon.
A linear incision was then made over the first MPJ with a #15 blade. The dissection was carried down to expose the joint capsule. Vital neurovascular structures, including the EHL tendon, were identified and retracted. A capsular incision was then made, and the head of the first metatarsal, as well as the base of the proximal phalanx were exposed and isolated. Large osteophytes were removed off the first metatarsal head and the base of the proximal phalanx with a rongeur. The medial eminence and large dorsal osteophyte were then resected with an oscillating saw. Wright Medical reaming system was then used to remove all cartilage off the head of the first metatarsal and the base of the proximal phalanx. Any remaining cartilage was removed with a curette, and then the subchondral bone of both the first metatarsal head and the base of the proximal phalanx was then perforated with a 2-0 drill bit to expose healthy medullary contents.
Vitoss bone graft was then combined with the bone marrow aspirate, and this slurry was then inserted into the arthrodesis site and packed into any remaining gaps. A 3.0 cannulated Wright Medical screw was then inserted through the arthrodesis site, and reduction of the deformity, as well as fixation of the arthrodesis, was noted at this time. A Wright Medical 0-degree first MTP plate was then placed dorsally on the arthrodesis site, and the screws listed in the materials section were inserted in the standard fashion. Position of the hallux was verified clinically, and the entire incision was then flushed with copious amounts of sterile normal saline. Any remaining defects medially and laterally, as well as underneath the plate, were packed with the remaining Vitoss graft. Capsular closure was then performed with 2-0 Vicryl. Skin closure was then performed with 4-0 V-Loc . This linear incision was then sealed with DermaFlex and Steri-Strips. The medial stab incision for the cannulated screw was then closed with 4-0 nylon. All 3 incisions were then dressed with Xeroform, sterile 4 x 4s, Webril, and Ace wraps.
The patient tolerated the procedure and anesthesia well. The patient left the OR to recovery room with vital signs stable and vascular status intact to the right lower extremity. No complications were noted throughout the procedure
