Jamie Dezenzo
True Blue
Hello all and HAPPY Tuesday!
PROCEDURE PERFORMED: Right midfoot exostectomy.
FINDINGS: The patient had a dorsal midfoot spur located to the intercuneiform joints today. She also had a hypertrophic extensor hallucis brevis muscle belly that was pressing on the deep peroneal nerve as it was running dorsally to both of these structures today.
INDICATIONS: This is a 47-year-old old female who is very active and enjoys working out and has had a significant amount of right midfoot pain lately. She has developed a right midfoot spur, which has been pressing on her neurovascular structures going dorsally on the foot. She has also developed a hypertrophic extensor hallucis brevis muscle belly, which has also been giving her neuritis-like symptoms.
Attention was directed to the dorsal aspect of the right midfoot, where a 5 cm incision was made. The incision was carried through the skin and soft tissue using sharp and blunt dissection. Blunt dissection was carried down to the dorsal midfoot, where at this time all care was to retract structures. The deep peroneal nerve was identified upon dissection. The patient had a very large hypertrophic extensor hallucis brevis muscle belly that was also pressing along this neurovascular bundle today. Some of this hypertrophic muscle belly was debrided using a sharp 15 blade today. Dissection was carefully taken down to the intercuneiform joints. There was a large dorsal midfoot spur located to this area. A sagittal saw was used to remove this spur along the intercuneiform joints. This was taken down to the good joints surfaces today. All rough edges were smoothed with rasp. This area was copiously irrigated with normal saline. There were no signs of impingement of the dorsal midfoot spur causing the pressure along the deep peroneal nerve today. This deep peroneal nerve was definitely decompressed with the combination of the midfoot spur as well as the debridement of the hypertrophic muscle belly
Also bill for the muscle belly debridement 28899 dx 728.89? Thoughts???
Thanks!
Jamie
PROCEDURE PERFORMED: Right midfoot exostectomy.
FINDINGS: The patient had a dorsal midfoot spur located to the intercuneiform joints today. She also had a hypertrophic extensor hallucis brevis muscle belly that was pressing on the deep peroneal nerve as it was running dorsally to both of these structures today.
INDICATIONS: This is a 47-year-old old female who is very active and enjoys working out and has had a significant amount of right midfoot pain lately. She has developed a right midfoot spur, which has been pressing on her neurovascular structures going dorsally on the foot. She has also developed a hypertrophic extensor hallucis brevis muscle belly, which has also been giving her neuritis-like symptoms.
Attention was directed to the dorsal aspect of the right midfoot, where a 5 cm incision was made. The incision was carried through the skin and soft tissue using sharp and blunt dissection. Blunt dissection was carried down to the dorsal midfoot, where at this time all care was to retract structures. The deep peroneal nerve was identified upon dissection. The patient had a very large hypertrophic extensor hallucis brevis muscle belly that was also pressing along this neurovascular bundle today. Some of this hypertrophic muscle belly was debrided using a sharp 15 blade today. Dissection was carefully taken down to the intercuneiform joints. There was a large dorsal midfoot spur located to this area. A sagittal saw was used to remove this spur along the intercuneiform joints. This was taken down to the good joints surfaces today. All rough edges were smoothed with rasp. This area was copiously irrigated with normal saline. There were no signs of impingement of the dorsal midfoot spur causing the pressure along the deep peroneal nerve today. This deep peroneal nerve was definitely decompressed with the combination of the midfoot spur as well as the debridement of the hypertrophic muscle belly
Also bill for the muscle belly debridement 28899 dx 728.89? Thoughts???
Thanks!
Jamie