Meljmichon
Guest
I am having a hard time figuring out which code i should be using for the : HIP OPEN IT BAND LENGTHENING. The pt also had an OPEN Trochanteric Bursectomy 27062 & OPEN Abductor Tendon Repair (unlisted compared to 27405).
I am debating between the 27025 or the 27305?
Here is the OP Note:
LEFT HIP TROCHANTERIC BURSECTOMY THE IT BAND LENGTHENING AND ABDUCTOR TENDON REPAIR: At this point, after having done a timeout then prepped and draped the patient having all the antibiotics being infused, a 10 cm incision was performed centered over the trochanteric bursa. Copious irrigation was performed. The dissection was then performed so that it went deep down through the subcutaneous fatty tissue down to the IT band. The IT band was incised in line with the incision. After the IT band was incised a huge amount of synovial fluid was identified. Copious irrigation was performed and there was extensive amounts of thick, hard scarred in bursitis that were noted in the trochanteric bursal area. At this point, the bursa was excised completely from the trochanteric space. Copious irrigation was performed. Once the bursa which was thickened and edematous was excised completely, we were then able to identify the abductor tendon. The abductor tendon had a partial high-grade tear all the way through. There was an area of abductor tendon tearing that was a full thickness tear. The tendon was debrided until a stable edge. The footprint of the tendon was debrided using a rongeur and curette. We could then get to good healthy bleeding bone. Two Smith and Nephew Healicoil 5.5 mm PEEK anchors were then placed at the footprint of the tendon, passing the 3 suture pairs in a horizontal mattress fashion through the tendon. The tendon was then reattached medially back to the footprint. Two Arthrex 4.75 mm BioComposite SwiveLock anchors were then placed laterally and 6 sutures were placed over the tendon in a lattice form fashion compressing creating a double row repair. Excellent tendon repair was noted back to the greater tuberosity. Copious irrigation was performed. The hip was rotated internally externally. The abductor tendon had been fully repaired down and there was no further gapping of the tendon. The footprint of the tendon was completely covered. Having resected the entire bursa irrigation was performed. The tendon repair had now been performed. At this point, we repaired the IT band in a longitudinal fashion. I created a small slit posteriorly at the very distal part of the IT band in the posterior leaflet and then anteriorly at the very proximal part of the IT band anterior leaflet. This in essence created a lengthening and then we created small perforations through the IT band throughout its course to create a full lengthening of the IT band. Then, using #1 Vicryl, the IT band was then repaired side-to-side and in fact that we had now created a Z lengthening. Copious irrigation was performed. The subcutaneous tissue was closed first with 2-0 Vicryl followed by 3-0 Monocryl in a subcuticular fashion. Mastisol, Steri-Strips, Xeroform, dry sterile dressings were applied.
Thank you
I am debating between the 27025 or the 27305?
Here is the OP Note:
LEFT HIP TROCHANTERIC BURSECTOMY THE IT BAND LENGTHENING AND ABDUCTOR TENDON REPAIR: At this point, after having done a timeout then prepped and draped the patient having all the antibiotics being infused, a 10 cm incision was performed centered over the trochanteric bursa. Copious irrigation was performed. The dissection was then performed so that it went deep down through the subcutaneous fatty tissue down to the IT band. The IT band was incised in line with the incision. After the IT band was incised a huge amount of synovial fluid was identified. Copious irrigation was performed and there was extensive amounts of thick, hard scarred in bursitis that were noted in the trochanteric bursal area. At this point, the bursa was excised completely from the trochanteric space. Copious irrigation was performed. Once the bursa which was thickened and edematous was excised completely, we were then able to identify the abductor tendon. The abductor tendon had a partial high-grade tear all the way through. There was an area of abductor tendon tearing that was a full thickness tear. The tendon was debrided until a stable edge. The footprint of the tendon was debrided using a rongeur and curette. We could then get to good healthy bleeding bone. Two Smith and Nephew Healicoil 5.5 mm PEEK anchors were then placed at the footprint of the tendon, passing the 3 suture pairs in a horizontal mattress fashion through the tendon. The tendon was then reattached medially back to the footprint. Two Arthrex 4.75 mm BioComposite SwiveLock anchors were then placed laterally and 6 sutures were placed over the tendon in a lattice form fashion compressing creating a double row repair. Excellent tendon repair was noted back to the greater tuberosity. Copious irrigation was performed. The hip was rotated internally externally. The abductor tendon had been fully repaired down and there was no further gapping of the tendon. The footprint of the tendon was completely covered. Having resected the entire bursa irrigation was performed. The tendon repair had now been performed. At this point, we repaired the IT band in a longitudinal fashion. I created a small slit posteriorly at the very distal part of the IT band in the posterior leaflet and then anteriorly at the very proximal part of the IT band anterior leaflet. This in essence created a lengthening and then we created small perforations through the IT band throughout its course to create a full lengthening of the IT band. Then, using #1 Vicryl, the IT band was then repaired side-to-side and in fact that we had now created a Z lengthening. Copious irrigation was performed. The subcutaneous tissue was closed first with 2-0 Vicryl followed by 3-0 Monocryl in a subcuticular fashion. Mastisol, Steri-Strips, Xeroform, dry sterile dressings were applied.
Thank you