KristinM522
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I'm trying to find a code for "resection ankle impingement".. I cant decide by this op note if it should be included in the arthrodesis or billed separate.. I know he is in separate compartments but there was only 1 incision.. Please help! Any advice would be appreciate, as I am new to podiatry coding.
Thank you in advance!
POSTOPERATIVE DIAGNOSES:
1. Ankle impingement, left.
2. Arthritis, talonavicular joint, left.
PROCEDURES:
1. Resection ankle impingement, left.
2. Arthrodesis, talonavicular joint, left. (CPT 28737?)
DESCRIPTION OF PROCEDURE:
An incision was made proximal to the ankle joint ending
distal to the talonavicular joint between the junction of the
anterior tibial and EHL tendons. The incision was carefully
deepened in a fascial plane manner, taking care to retract and
protect neurovascular structures. Small veins were clamped and
bovied as necessary. Subperiosteal dissection was then carried
out exposing the ankle joint and the talonavicular joint. A
malleable retractor was placed into the ankle joint and the large
lipping of the tibia was then resected with an osteotome and
mallet until satisfactory resection had been performed. The area
was smoothed down with a power rasp and then bone wax was applied.
The area was irrigated and there was a small osteochondral
fragment noted floating in the lateral gutter, and this was
removed as well.
Next, after soft tissues were freed about the talonavicular joint,
a mini-external fixator was utilized with 2 dorsal plantar 0.062
K-wires for provisional distraction. The joint was then debrided,
maintaining its ball and cup-type architecture using a power bur
to resect the cartilage. Once this was satisfactory, the chondral
plate on each side was fish-scaled with an osteotome and mallet.
Once this was satisfactory and peripheral osteophytes had been
satisfactorily debrided, 2 guide pins were placed percutaneously
from the navicular tuberosity and verified fluoroscopically, and
then a small skin incision was made with blunt dissection down to
bone about each pin, and appropriate-sized 4-0 cannulated screw
was inserted, providing interfragmentary compression which was
satisfactory and verified for position, length, and compression
fluoroscopically.
Next, the more central and lateral aspect of the talonavicular
joint was compressed utilizing a dorsal plantar Memory Staple.
This was inserted under standard technique and tamped down to bone
with satisfactory compression as well.
Thank you in advance!
POSTOPERATIVE DIAGNOSES:
1. Ankle impingement, left.
2. Arthritis, talonavicular joint, left.
PROCEDURES:
1. Resection ankle impingement, left.
2. Arthrodesis, talonavicular joint, left. (CPT 28737?)
DESCRIPTION OF PROCEDURE:
An incision was made proximal to the ankle joint ending
distal to the talonavicular joint between the junction of the
anterior tibial and EHL tendons. The incision was carefully
deepened in a fascial plane manner, taking care to retract and
protect neurovascular structures. Small veins were clamped and
bovied as necessary. Subperiosteal dissection was then carried
out exposing the ankle joint and the talonavicular joint. A
malleable retractor was placed into the ankle joint and the large
lipping of the tibia was then resected with an osteotome and
mallet until satisfactory resection had been performed. The area
was smoothed down with a power rasp and then bone wax was applied.
The area was irrigated and there was a small osteochondral
fragment noted floating in the lateral gutter, and this was
removed as well.
Next, after soft tissues were freed about the talonavicular joint,
a mini-external fixator was utilized with 2 dorsal plantar 0.062
K-wires for provisional distraction. The joint was then debrided,
maintaining its ball and cup-type architecture using a power bur
to resect the cartilage. Once this was satisfactory, the chondral
plate on each side was fish-scaled with an osteotome and mallet.
Once this was satisfactory and peripheral osteophytes had been
satisfactorily debrided, 2 guide pins were placed percutaneously
from the navicular tuberosity and verified fluoroscopically, and
then a small skin incision was made with blunt dissection down to
bone about each pin, and appropriate-sized 4-0 cannulated screw
was inserted, providing interfragmentary compression which was
satisfactory and verified for position, length, and compression
fluoroscopically.
Next, the more central and lateral aspect of the talonavicular
joint was compressed utilizing a dorsal plantar Memory Staple.
This was inserted under standard technique and tamped down to bone
with satisfactory compression as well.