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Patient is brought in the operating present operatively supine position. A tourniquet was placed on the patient's right ankle. General anesthesia was achieved. The foot was then scrubbed prepped and draped in usual aseptic manner. The foot was then elevated tourniquet inflated. Next 3 stab incisions were made on the Achilles tendon roughly 1 to 1-1/2 cm apart from 1 another. Through the stab incisions the tendon was then lengthened, the Achilles tendon was then lengthened and we did feel a legitimate lengthening with some dorsiflexion. The stab incisions were then closed with suture. Next an incision was made on the first metatarsal. The incision was deepened taking care to identify retract all vital neurovascular structures. All bleeders were cauterized and ligated as necessary. Next a first interspace was performed. The fibular sesamoid was then freed and removed. The fibular sesamoid was then a bad position. Next a straight linear capsulotomy was performed. The first metatarsal head and the base of the proximal phalanx were exposed at the operative site. Next utilizing a reaming system the cartilage from the first metatarsal head and the base of the proximal phalanx were resected and passed from the operative site. Next some additional remodeling at the base of the proximal phalanx was performed. Next the fusion site was then fenestrated. Next this was then fixated with a dorsal compression plate with excellent compression noted. There was still a rigid deformity noted at the inner phalangeal joint and an IPJ arthroplasty was performed. Correction of these deformities were assessed and noted to be adequate. At this point I took a biologic spacer, a flex graft was then placed in the interphalangeal joint to allow for motion and a flexible K wire was then driven across the inner phalangeal joint and across the fusion site to stabilize the toe. Wounds were then flushed and closed in layers. Next an incision was made in between the second and third metatarsals. The incision was deepened taking care to identify and retract all vital neurovascular structures. All bleeders were cauterized and ligated as necessary. Next the extensor digitorum brevis tendon was released at the second and third toes. The extensor digitorum longus tendons were preserved and retracted out of the way. Next a completely dislocated second MPJ and third MPJ were noted in the surgical site. McGlamry elevator was then utilized to release the soft tissue adhesions. The second metatarsal head and the third metatarsal head were removed and passed from the operative site. Next a PIPJ arthroplasty was performed at the second toe. Next a K wire was then driven down the second toe retrograded into the proximal phalanx across the second MPJ and into the second metatarsal. The same procedure was then duplicated for the third toe and third metatarsal. Correction of these deformities was assessed and noted to be excellent. Wounds were then flushed and closed. Flexor tenotomy was also performed on the plantar surface of the toes 234 and 5. Next incision was made between the fourth and fifth metatarsals. The incision was deepened. Once again the extensor brevis on the fourth was identified and released. The fourth metatarsal head was exposed at the operative site the fifth metatarsal head was exposed at the operative site. The fourth met head and fifth met head were removed and passed from the operative site. Arthroplasty was performed on the fifth toe. An arthroplasty was also performed on the fourth toe. K wire was then driven down the length of the fourth and fifth toes and into the fourth and fifth metatarsals. Correction was assessed notably absent. Wounds were then flushed and closed in layers.
Having trouble putting codes to this op report. any help is appreciated .
this is what my office has come up with so far.
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28114- RT
28750 - TA
28285/59 – T6
28285/59 – T7
28285/59 – T8
28285/59 – T9
27685 ?
Having trouble putting codes to this op report. any help is appreciated .
this is what my office has come up with so far.
----------------
28114- RT
28750 - TA
28285/59 – T6
28285/59 – T7
28285/59 – T8
28285/59 – T9
27685 ?