cclarson
Guru
A doctor performed a Modified McBride bunionectomy with Lapidus arthrodesis (these two procedures would be coded as 28297?) first metatarsal cuneiform joint. During the operation, he accidentally cut into the pt's tendon, stating that there was an "Inadvertent release of the extensor hallucis longus tendon requiring harvesting of tendon graft from tibialis anterior and suturing across the defect. This was immediate after the other procedures had been completed."
How would I code this complication? For the Dx, I was going to use M96.820 for accidental puncture/laceration a musculoskeletal structure during a musculoskeletal system procedure. Would this be correct, or would I need to also include a separate tendon laceration code?
Also, for the tendon harvest he had to do to fix his mistake, what cpt code would be most appropriate?
Here is the op note:
POSTOPERATIVE DIAGNOSIS:
Painful severe hallux valgus deformity, left foot.
OPERATION PERFORMED:
Modified McBride bunionectomy with Lapidus arthrodesis first metatarsal cuneiform joint.
DESCRIPTION OF PROCEDURE:
Attention was directed to the dorsomedial aspect of the first metatarsal cuneiform joint. A 5 cm linear incision was created centered over the joint. The incision was deepened to deep fascia. The deep fascia was incised and reflected. The joint was prepared for arthrodesis by resecting articular cartilage on both sides of the joint with special attention to feather and resect the lateral portion of the medial cuneiform to reduce as much as possible the severe intermetatarsal angle. Once this had been accomplished, the first metatarsal cuneiform was temporarily fixated with a 0.062 smooth K-wire to facilitate the insertion of a 36 mm 4.0 headless compression screw oriented from dorsal to plantar and distal to proximal across the first metatarsal cuneiform joint. The arthrodesis was noted to be fairly compressed and arthrodesed following the insertion of the screw, although the fixation was augmented by the application of a 6 hole straight compression plate which was placed medially centered over the first metatarsal cuneiform joint. Three of holes were inserted in locking fashion. One of the holes was inserted with a cortical screw to lag the plate down to the bone. Intraoperative x-rays validated satisfactory position of the internal fixation.
Attention was then directed distally to the first metatarsophalangeal joint. A 4 cm curvilinear incision was created centered over the dorsomedial aspect of the joint. The incision was deepened to deep fascia. The deep fascia was incised and reflected. The dorsomedial eminence was conservatively resected. Attempted were made to explore the interspace. However, upon dissecting laterally, unfortunately, the extensor hallucis longus tendon was noted to be completely released. Decision, obviously, was made at that time to perform primary closure. The proximal and distal portions of the tendon were identified. Due to the concern about suturing end to end closure or repair under tension, a portion of the tibialis anterior tendon was harvested proximally. This was approximately 5 to 6 cm. It was laid across the defect and sutured with 2-0 PDS suture. At the conclusion of the repair, the tendon was noted to be under physiologic tension with no excessive tension or gapping.
How would I code this complication? For the Dx, I was going to use M96.820 for accidental puncture/laceration a musculoskeletal structure during a musculoskeletal system procedure. Would this be correct, or would I need to also include a separate tendon laceration code?
Also, for the tendon harvest he had to do to fix his mistake, what cpt code would be most appropriate?
Here is the op note:
POSTOPERATIVE DIAGNOSIS:
Painful severe hallux valgus deformity, left foot.
OPERATION PERFORMED:
Modified McBride bunionectomy with Lapidus arthrodesis first metatarsal cuneiform joint.
DESCRIPTION OF PROCEDURE:
Attention was directed to the dorsomedial aspect of the first metatarsal cuneiform joint. A 5 cm linear incision was created centered over the joint. The incision was deepened to deep fascia. The deep fascia was incised and reflected. The joint was prepared for arthrodesis by resecting articular cartilage on both sides of the joint with special attention to feather and resect the lateral portion of the medial cuneiform to reduce as much as possible the severe intermetatarsal angle. Once this had been accomplished, the first metatarsal cuneiform was temporarily fixated with a 0.062 smooth K-wire to facilitate the insertion of a 36 mm 4.0 headless compression screw oriented from dorsal to plantar and distal to proximal across the first metatarsal cuneiform joint. The arthrodesis was noted to be fairly compressed and arthrodesed following the insertion of the screw, although the fixation was augmented by the application of a 6 hole straight compression plate which was placed medially centered over the first metatarsal cuneiform joint. Three of holes were inserted in locking fashion. One of the holes was inserted with a cortical screw to lag the plate down to the bone. Intraoperative x-rays validated satisfactory position of the internal fixation.
Attention was then directed distally to the first metatarsophalangeal joint. A 4 cm curvilinear incision was created centered over the dorsomedial aspect of the joint. The incision was deepened to deep fascia. The deep fascia was incised and reflected. The dorsomedial eminence was conservatively resected. Attempted were made to explore the interspace. However, upon dissecting laterally, unfortunately, the extensor hallucis longus tendon was noted to be completely released. Decision, obviously, was made at that time to perform primary closure. The proximal and distal portions of the tendon were identified. Due to the concern about suturing end to end closure or repair under tension, a portion of the tibialis anterior tendon was harvested proximally. This was approximately 5 to 6 cm. It was laid across the defect and sutured with 2-0 PDS suture. At the conclusion of the repair, the tendon was noted to be under physiologic tension with no excessive tension or gapping.
