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pshaw08

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the skin incision was made along the
lateral border of the fifth metatarsal and carried down through subcutaneous
tissue with sharp and blunt dissection. The fifth ray was resected at the
base of the fifth metatarsal. Additional putrid material was noted medial
to this and deep in the tendon sheath. The fourth ray was then resected in
a similar fashion. Additional putrid material was noted medial to this, so
the third metatarsal was excised retaining the blood flow to the third toe.
The various tendon sheaths were opened and purulent material obtained. The
tendons were trimmed back to normal tissue.

any thoughts on how this should be coded, we have several different opinions.

thank you
 
than
After the necrotic wound edges were debrided back further, the fifth
metatarsal was excised down to the peroneus brevis tendon with only the
small portion of the tubercle left intact since it was still attached to the
adjacent cuboid. The third and fourth metatarsal bases were disarticulated
from the tarsal bones. The wound could still not be closed without any
tension, so the third toe was excised and then the second toe was
disarticulated from the second metatarsal, which was excised, leaving only
the keystone base of it. This allowed closure without tension, except for a
small area, which was left open at the center of the wound.
k you! patient returned to operating room 2 days later with complications can you give me your thoughts on them?
 
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