such78
Expert
Post op dx:
1. chronic diabetic nonhealing ulcer, left plantar hallux
2. Prominent interphalange sesamoid, left planta hallux
1. attention was directed to the plantar aspect of the hallux and overlying the chronic ulceration in question, where approximately two 2 cm curvilinear skin incisions were made around the skin ulcer. This initial inscion was deepened via sharp and blunt dissection, being careful to retract vital structures and ligate superficial vessels. The full thickness ulcer was excised , removed, and sent to pathology for evaluation. All areas of scar tissue and devitalized tissue were removed. There area was copiously irrigated with saline and Bacitracin solution with closure in layers of 2-0 vicryl and 3-0 nylon.
2. attention was directed to the medial aspect of the hallux directly plantar medial to the bone protuberance in question, where an approximately 2 cm longitudinal incision was made overlying the bone protuberance. This initial incision was deepened via sharp and blunt dissection being careful to retract vital structures and ligate superficial vessels. Once the periosteal structures were reached, a linear incision was made through them. There were retracted medially and laterally in order to expose the esostosis in question. The exostosis was articulating, but base of the distal and proximal phalanx was identified with blunt dissection and removed sharply with rongeur and sharp 15 blade. The area underlying was rasped smooth with a power rasp.
I assign
28124 - TA for excision exostosis by base of the distal and proximal phalanx dissection.
11042 -XU for debrided nonhealing ulcer ( subcutaneous)
12032 -XU for two 2 cm skin incision ( two 2 cm incision)
I add modifier " XU" for both because NCCI edit is present with 28124). because surgeon used different approach for these 2 procedures, I think both codes are not a pair with 28124.
Please advice.
Thank you
1. chronic diabetic nonhealing ulcer, left plantar hallux
2. Prominent interphalange sesamoid, left planta hallux
1. attention was directed to the plantar aspect of the hallux and overlying the chronic ulceration in question, where approximately two 2 cm curvilinear skin incisions were made around the skin ulcer. This initial inscion was deepened via sharp and blunt dissection, being careful to retract vital structures and ligate superficial vessels. The full thickness ulcer was excised , removed, and sent to pathology for evaluation. All areas of scar tissue and devitalized tissue were removed. There area was copiously irrigated with saline and Bacitracin solution with closure in layers of 2-0 vicryl and 3-0 nylon.
2. attention was directed to the medial aspect of the hallux directly plantar medial to the bone protuberance in question, where an approximately 2 cm longitudinal incision was made overlying the bone protuberance. This initial incision was deepened via sharp and blunt dissection being careful to retract vital structures and ligate superficial vessels. Once the periosteal structures were reached, a linear incision was made through them. There were retracted medially and laterally in order to expose the esostosis in question. The exostosis was articulating, but base of the distal and proximal phalanx was identified with blunt dissection and removed sharply with rongeur and sharp 15 blade. The area underlying was rasped smooth with a power rasp.
I assign
28124 - TA for excision exostosis by base of the distal and proximal phalanx dissection.
11042 -XU for debrided nonhealing ulcer ( subcutaneous)
12032 -XU for two 2 cm skin incision ( two 2 cm incision)
I add modifier " XU" for both because NCCI edit is present with 28124). because surgeon used different approach for these 2 procedures, I think both codes are not a pair with 28124.
Please advice.
Thank you
Last edited: