How do I code Pemberton osteotomy of the left acetabulum (for development dysplasia of hip)? It looks more than just CPT 27146 (physician bills)..
Below is the note:
Procedure Performed: Open reduction and capsulorrhaphy of the left hip. Pemberton osteotomy of the left acetabulum
An incision was made over the left iliac crest extending down into the bikini line. We dissected sharply down through skin and subcutaneous tissue we then identified the Smith-Petersen interval and dissected with electrocautery and then bluntly to protect the LF CN down around the rectus tendon. We then proceeded proximally and split the lateral third of the iliac crest apophysis dissecting the abductors laterally off of the outer table of the ilium down to the level of the capsule. We then used Bovie electrocautery and Cobb
The capsule laterally and then turned our attention to the rectus. We divided the direct and indirect heads of the rectus and tagged them. I then proceeded to expose medially. I dissected subperiosteally on the medial aspect of the inner table between the ASIS and the AIIS I then dissected over out onto the ramus and then performed a psoas tendon lengthening over the brim. I was very careful to identify the psoas tendon and stimulated with electrocautery to ensure that it is not femoral nerve. After I had released the psoas tendon I was able to expose the capsule medially a little bit better. I then performed a standard T capsulotomy and exposed the femoral head. The femoral head was round and the cartilage was in good condition. It was dislocatable easily so I removed the ligamentum teres and the pulmonary and divided the transverse acetabular ligament to allow to sleep more deeply in the acetabulum. At this point I turned my attention to the dysplastic acetabulum which was deficient anteriorly and laterally. I used osteotomes to make a standard Pemberton osteotomy cutting the inner and outer table and curving down toward the medial limb of the triradiate cartilage. I then levered this down and selected a piece of femoral neck allograft to used all the osteotomy in place. I spread it with lamina spreaders and then impacted the graft with a tamp. There is excellent inherent stability. I then turned my attention to capsulorrhaphy and I placed 4 stitches on the medial aspect of the capsule with #2 FiberWire and then closed these
Below is the note:
Procedure Performed: Open reduction and capsulorrhaphy of the left hip. Pemberton osteotomy of the left acetabulum
An incision was made over the left iliac crest extending down into the bikini line. We dissected sharply down through skin and subcutaneous tissue we then identified the Smith-Petersen interval and dissected with electrocautery and then bluntly to protect the LF CN down around the rectus tendon. We then proceeded proximally and split the lateral third of the iliac crest apophysis dissecting the abductors laterally off of the outer table of the ilium down to the level of the capsule. We then used Bovie electrocautery and Cobb
The capsule laterally and then turned our attention to the rectus. We divided the direct and indirect heads of the rectus and tagged them. I then proceeded to expose medially. I dissected subperiosteally on the medial aspect of the inner table between the ASIS and the AIIS I then dissected over out onto the ramus and then performed a psoas tendon lengthening over the brim. I was very careful to identify the psoas tendon and stimulated with electrocautery to ensure that it is not femoral nerve. After I had released the psoas tendon I was able to expose the capsule medially a little bit better. I then performed a standard T capsulotomy and exposed the femoral head. The femoral head was round and the cartilage was in good condition. It was dislocatable easily so I removed the ligamentum teres and the pulmonary and divided the transverse acetabular ligament to allow to sleep more deeply in the acetabulum. At this point I turned my attention to the dysplastic acetabulum which was deficient anteriorly and laterally. I used osteotomes to make a standard Pemberton osteotomy cutting the inner and outer table and curving down toward the medial limb of the triradiate cartilage. I then levered this down and selected a piece of femoral neck allograft to used all the osteotomy in place. I spread it with lamina spreaders and then impacted the graft with a tamp. There is excellent inherent stability. I then turned my attention to capsulorrhaphy and I placed 4 stitches on the medial aspect of the capsule with #2 FiberWire and then closed these