Looking for Podiatry coding help. The patient previously had a transmetatarsal amputation and returned to OR due to progressive necrosis and I am unsure what cpt code would be best. Excerpt from the op report:
Attention was directed to the open portion of right foot transmetatarsal amputation. Quick inspection was conducted and noted progressed necrosis from previous inpatient hospital encounters, with exposed metatarsal bones 1 through 5 which were dusky devitalized discolored black/grayish/yellowish and nonviable. The tissue was dyed using methylene blue. Utilizing fresh sterile #15 blade the necrotic portion of transmetatarsal amputation site was excised, including nonviable nonhealing edges of the wound were debrided to healthy viable granular bleeding tissue. Bulk areas of necrosis were excised with a fresh sterile #15 blade from the wound bed. Metatarsals were then disarticulated individually utilizing a fresh sterile #15 blade at the level of the Lisfranc joint articulation, these were then passed off the field and sent for pathology. Utilizing an oscillating sagittal saw necrotic nonviable devitalized cartilage of cuneiforms and tarsal bones were resected to healthy viable bleeding bone. Bluish discoloration was noted to the medial cuneiform and cuboid bone. A portion of the medial cuneiform was sent to pathology. Further excisional debridement was performed with the Versajet to the level of bone until healthy bleeding edges were noted. A pulse lavage was then utilized on a 3 L bag of sterile saline was used to copiously irrigate right foot amputation site. Deep tissue cultures were taken. Post debridement wound measurement approximately 10cm x 7cm x 0.5cm. Closure of the site was deemed unfeasible so the decision was then made to apply a wound VAC KCI NPWT system was then applied to promote healing and granulation tissue formation over the bone. However bleeding then ensued and coagulated within the wound VAC sponge and occluded the system. The decision was made to abandon the KCI wound vacuum system until a later date, TBD, and apply a pressure dressing. First hemostasis was achieved by application of Arista powder, fibrillar and Surgicel directly to the wound bed. A pressure dressing was applied composed of 4 x 4 gauze, sterile ABD pads, sterile Kerlix wrap, further ABD pads, sterile Kerlix wrap which was then compressed via Ace bandage. Patient tolerated procedure well no inciting events or complications. Patient was transferred from the OR to PACU
71 y.o. male who is having surgery for right transmetatarsal amputation site with wound dehiscence and necrosis. Patient has necrosis of amputation site and require surgical debridement
Attention was directed to the open portion of right foot transmetatarsal amputation. Quick inspection was conducted and noted progressed necrosis from previous inpatient hospital encounters, with exposed metatarsal bones 1 through 5 which were dusky devitalized discolored black/grayish/yellowish and nonviable. The tissue was dyed using methylene blue. Utilizing fresh sterile #15 blade the necrotic portion of transmetatarsal amputation site was excised, including nonviable nonhealing edges of the wound were debrided to healthy viable granular bleeding tissue. Bulk areas of necrosis were excised with a fresh sterile #15 blade from the wound bed. Metatarsals were then disarticulated individually utilizing a fresh sterile #15 blade at the level of the Lisfranc joint articulation, these were then passed off the field and sent for pathology. Utilizing an oscillating sagittal saw necrotic nonviable devitalized cartilage of cuneiforms and tarsal bones were resected to healthy viable bleeding bone. Bluish discoloration was noted to the medial cuneiform and cuboid bone. A portion of the medial cuneiform was sent to pathology. Further excisional debridement was performed with the Versajet to the level of bone until healthy bleeding edges were noted. A pulse lavage was then utilized on a 3 L bag of sterile saline was used to copiously irrigate right foot amputation site. Deep tissue cultures were taken. Post debridement wound measurement approximately 10cm x 7cm x 0.5cm. Closure of the site was deemed unfeasible so the decision was then made to apply a wound VAC KCI NPWT system was then applied to promote healing and granulation tissue formation over the bone. However bleeding then ensued and coagulated within the wound VAC sponge and occluded the system. The decision was made to abandon the KCI wound vacuum system until a later date, TBD, and apply a pressure dressing. First hemostasis was achieved by application of Arista powder, fibrillar and Surgicel directly to the wound bed. A pressure dressing was applied composed of 4 x 4 gauze, sterile ABD pads, sterile Kerlix wrap, further ABD pads, sterile Kerlix wrap which was then compressed via Ace bandage. Patient tolerated procedure well no inciting events or complications. Patient was transferred from the OR to PACU
71 y.o. male who is having surgery for right transmetatarsal amputation site with wound dehiscence and necrosis. Patient has necrosis of amputation site and require surgical debridement