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Thomas Smith
AGE: 82
Private Payer (Medicare rules for 65 and older)

Date of Service: 1/1/20XX
Service Department: Orthopedic Group General
Provider: Dr. Brandon Thomas

OPERATIVE NOTE:
PREOPERATIVE DIAGNOSIS: Primary Osteoarthritis right hip.
POSTOPERATIVE DIAGNOSIS: Primary Osteoarthritis right hip.
NAME OF PROCEDURE: Right AML Pressfit metal-on-metal total hip arthroplasty.
SURGEON: Brandon Thomas, MD
ASSISTANT: Anne Jones, PA-C
DESCRIPTION OF PROCEDURE: The patient was given 1 gm of vancomycin slowly IV, then a general anesthetic. He was placed in the right lateral position where his right hip and lower extremity prepped and draped in the usual sterile fashion. Spacesuits were used.
A straight lateral approach was made and carefully carried down to the fascia lata which was split. Bleeders were cauterized. A Charnley retractor was placed in the anterior one-half of the gluteus medius and minimus freeing the greater trochanter. The capsule was opened anterolaterally in a T-shaped fashion.
The hip was dislocated. The neck was sectioned at the appropriate level for the AML component. The acetabular ligament was excised. We irrigated with PB solution, removed the anterior lip and then we deepened and reamed to a 58 outside diameter. The wound was thoroughly irrigated with PB solution and then the spiked pore coated 58 outside diameter AML cup was impacted in 15 degrees of anteversion and a hole eliminator was applied. The wound was irrigated with PB solution and a 40 inside diameter metal-on-metal component was impacted.
Attention was turned to the proximal femur which was prepared with the reamers and broaches to accept a standard 12. The wound was again irrigated with PB solution. Then the standard
fully coated standard 12 AML component was impacted in the neutral position. There was a proximal crack medially and we passed on 2-mm eerclage wire to keep this crack from propagating. Trial reduction with a +5 gave excellent stability and leg length. Therefore the +5 neck, 40 headed component was impacted. The hip was irrigated with PB solution and reduced under direct vision.
The right lower extremity was placed on the Mayo stand. One deep Hemovac drain was placed through a separate stab incision. The wound was redraped and irrigated with BP solution. The capsule was then reapproximated with interrupted 2-0 Ethibond. The gluteus medius and minimus were reattached to the greater trochanter with interrupted 2 Ethibond and running 2 Vicryl. The wound was irrigated with PB solution. The fascia lata was closed with interrupted 2 Ethibond and running looped 1 PDS suture.
The subcutaneous tissue was irrigated with PB solution and closed with interrupted #2 and 2-0 Vicryl and the skin was closed with staples. A Bacitracin ointment soft supportive dressing was applied.
The sponge and sharp counts were correct. A hip abduction pillow was inserted. The patient was gently turned back to supine position and transferred to his bed. He tolerated the procedure well.
Brandon Thomas, MD
Electronically signed by BRANDON THOMAS, MD 1/1/20XX

FOR THIS QUESTION I DID CORRECT CODES BUT DUE NOT PUTTING UNIT 1 I LOST 1 MARK. WHY IS THAT? IF ANYONE CAN HELP ME WHAT UNITS MEAN IN PRACTICODE THANKS
 
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