cclarson
Guru
Hello Everyone, I'm not sure how I should code this procedure as well as a neurectomy for the superficial peroneal nerve. Am I overthinking it and should just code it as a nerve decompression? Or is there a more accurate code for these two procedures? I don't feel that a neuroma excision would work, it looks more like the nerves for transferred. Any help would be deeply appreciated! Thank you in advance!
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Chronic pain of the left hallux with entrapment of the medial digital branch to the left hallux as well as the superficial peroneal nerve to the lateral aspect of the hallux as well as the deep peroneal nerves.
OPERATIONS PERFORMED:
1. Neurectomy of the medial digital branch.
2. Neurectomy of the superficial peroneal branch to the lateral aspect of the left hallux.
3. Neurolysis of the deep peroneal nerve.
DESCRIPTION OF PROCEDURE:
The patient was brought into the OR and placed in supine on the table. General anesthesia was initiated. The left lower extremity was prepped and draped in the normal sterile fashion. Attention was directed to the medial aspect of the foot where an 8-cm incision was created overlying the medial aspect of the first metatarsal. The nerve to the medial aspect of the hallux was identified. It was severed and redirected proximally underneath the skin where it was cut and buried in the subcutaneous tissue in the lower leg. The lateral branch of the superficial peroneal nerve was also identified, retracted proximally, and buried in the same subcutaneous tunnel. The incision was flushed with saline and closed with 4-0 Vicryl for subcutaneous closure and 4-0 nylon for skin closure. Attention was directed lateral on the dorsal aspect of the foot where an incision was made at the junction of the base of the first and second metatarsal. The incision was deepened to the deep fascia. The tendon slip of the extensor hallucis brevis was identified and cut. The deep peroneal nerve was noted to be significantly compressed underneath the tendon slip. The decision was made not to perform neurectomy of the deep peroneal nerve but instead neurolysis. The wound was flushed with copious amounts of sterile saline. The subcutaneous tissues were closed with 4-0 Vicryl and the skin was closed with 4-0 nylon. The above-noted amounts of local anesthetic were then injected about each surgical site.
The foot was bandaged with Xeroform gauze, dry sterile dressing, Kling, and Coban. The patient left the OR in stable condition. He will be discharged to Recovery with appropriate postoperative instructions and follow up in Dr. Hamilton's office next week.
Here is the report:
POSTOPERATIVE DIAGNOSIS:
Chronic pain of the left hallux with entrapment of the medial digital branch to the left hallux as well as the superficial peroneal nerve to the lateral aspect of the hallux as well as the deep peroneal nerves.
OPERATIONS PERFORMED:
1. Neurectomy of the medial digital branch.
2. Neurectomy of the superficial peroneal branch to the lateral aspect of the left hallux.
3. Neurolysis of the deep peroneal nerve.
DESCRIPTION OF PROCEDURE:
The patient was brought into the OR and placed in supine on the table. General anesthesia was initiated. The left lower extremity was prepped and draped in the normal sterile fashion. Attention was directed to the medial aspect of the foot where an 8-cm incision was created overlying the medial aspect of the first metatarsal. The nerve to the medial aspect of the hallux was identified. It was severed and redirected proximally underneath the skin where it was cut and buried in the subcutaneous tissue in the lower leg. The lateral branch of the superficial peroneal nerve was also identified, retracted proximally, and buried in the same subcutaneous tunnel. The incision was flushed with saline and closed with 4-0 Vicryl for subcutaneous closure and 4-0 nylon for skin closure. Attention was directed lateral on the dorsal aspect of the foot where an incision was made at the junction of the base of the first and second metatarsal. The incision was deepened to the deep fascia. The tendon slip of the extensor hallucis brevis was identified and cut. The deep peroneal nerve was noted to be significantly compressed underneath the tendon slip. The decision was made not to perform neurectomy of the deep peroneal nerve but instead neurolysis. The wound was flushed with copious amounts of sterile saline. The subcutaneous tissues were closed with 4-0 Vicryl and the skin was closed with 4-0 nylon. The above-noted amounts of local anesthetic were then injected about each surgical site.
The foot was bandaged with Xeroform gauze, dry sterile dressing, Kling, and Coban. The patient left the OR in stable condition. He will be discharged to Recovery with appropriate postoperative instructions and follow up in Dr. Hamilton's office next week.