nsteinhauser
Expert
I'm looking for opinions. Over 6 months ago, patient rolled ankle. Xrays at the time showed no bone disruption. Now xrays show a piece of loose bone at the end of the fibula. The surgeon removed a piece of distal fibula that avulsed (either at the CFL or ATFL attachment). Then surgeon did a right lateral ligament repair (both CFL and ATFL) from talus to fibula with an internal anchor. Surgeon's office coded 27641 with the 27698. I'm having trouble with that. My thinking is that taking that avulsed piece of bone off the end of the fibula would be part of the lateral ligament repair. But I could be wrong. Wouldn't be the first time.
Thank you in advance for any thoughts.
"A new incision was made over the distal fibula towards the 4th metatarsal down through skin and subcutaneous tissue. Bovie electrocautery was used for hemostasis. I cleared off the peroneal tendons posteriorly. They were both intact with no synovitis or split tears within them. I came through the distal fibula through the anterior capsule, ATFL and CFL with 15 blade. I cleaned off the distal aspect of the fibula with a rongeur and a curette. The avulsion injury was located both clinically as well as on C-arm fluoroscopy. It was removed with a rongeur. I made sure there was no further impingement in the lateral gutter. The PA retracted the soft tissues for visualization. We then made a small stab incision on the lateral aspect of the talus. I then placed the small K-wire for the Q fix anchor into the lateral talus. I confirmed it was in the appropriate position. I then over-reamed the K-wire. We then impacted the Smith and Nephew Q fix anchor into the lateral talus. The UltraTape was then passed into the Smith and Nephew footprint anchor. I also placed a #2 Ultrabraid into the Smith and Nephew footprint anchor. The PA then held the foot in a dorsiflexed and everted position. I then drilled and impacted the footprint anchor into the distal fibula. The tape was pulled tight. I then oversewed the anterior capsule with #2 Ultrabraid suture. I then repaired the CFL with the UltraTape suture."
Thank you in advance for any thoughts.
"A new incision was made over the distal fibula towards the 4th metatarsal down through skin and subcutaneous tissue. Bovie electrocautery was used for hemostasis. I cleared off the peroneal tendons posteriorly. They were both intact with no synovitis or split tears within them. I came through the distal fibula through the anterior capsule, ATFL and CFL with 15 blade. I cleaned off the distal aspect of the fibula with a rongeur and a curette. The avulsion injury was located both clinically as well as on C-arm fluoroscopy. It was removed with a rongeur. I made sure there was no further impingement in the lateral gutter. The PA retracted the soft tissues for visualization. We then made a small stab incision on the lateral aspect of the talus. I then placed the small K-wire for the Q fix anchor into the lateral talus. I confirmed it was in the appropriate position. I then over-reamed the K-wire. We then impacted the Smith and Nephew Q fix anchor into the lateral talus. The UltraTape was then passed into the Smith and Nephew footprint anchor. I also placed a #2 Ultrabraid into the Smith and Nephew footprint anchor. The PA then held the foot in a dorsiflexed and everted position. I then drilled and impacted the footprint anchor into the distal fibula. The tape was pulled tight. I then oversewed the anterior capsule with #2 Ultrabraid suture. I then repaired the CFL with the UltraTape suture."