Jamie Dezenzo
True Blue
Pre/Post Dx: nonunion of medial cuneiform osteotomy, right foot, with symptomatic implant
Procedure: Revision with take down of medial cuneiform osteotomy/grafting/internal fixation
Attention was directed to the previously well-healed surgical incision over the 1st cuneiform on the right foot. A 3 to 4 cm longitudinal incision was made over the previous incision with a #15 blade. This was deepened with a combination of sharp and blunt dissection down to the deep fascia. The deep fascia was incised, exposing the medial cuneiform. There was a titanium wedge present at the dorsum of the medial cuneiform. This was freed up from the surrounding attachments and removed from the operative site with a hemostat. It was noted that the bone was not completely healed around the wedge and there was some motion around the wedge prior to removal. After the wedge was removed, there was some fibrous tissue at the osteotomy site. This was debrided with a rongeur and curette in order to remove all fibrous tissue down to bleeding bony surfaces. Once the osteotomy site was adequately debrided, the incision was irrigated. The Vitoss graft was used to pack into the osteotomy site. The osteotomy was closed down with a small penetrating bone clamp and fixated using a Stryker 4-hole titanium plate and 4 Stryker 2.3 mm cortical screws placed from dorsal to plantar over the osteotomy site. This provided secure fixation of the osteotomy site. This was visualized with fluoroscopy. Multiple fluoroscopic views were saved and printed, showing fixation of the osteotomy. The incision was again irrigated. The deep fascia was reapproximated with 2-0 Vicryl; subcutaneous structures reapproximated with 3-0 Vicryl; skin was closed with 4-0 Prolene in a horizontal mattress suture .....
Help with codes??? Still use 28320 w/ nonunion fx dx???
Thanks
Jamie
Procedure: Revision with take down of medial cuneiform osteotomy/grafting/internal fixation
Attention was directed to the previously well-healed surgical incision over the 1st cuneiform on the right foot. A 3 to 4 cm longitudinal incision was made over the previous incision with a #15 blade. This was deepened with a combination of sharp and blunt dissection down to the deep fascia. The deep fascia was incised, exposing the medial cuneiform. There was a titanium wedge present at the dorsum of the medial cuneiform. This was freed up from the surrounding attachments and removed from the operative site with a hemostat. It was noted that the bone was not completely healed around the wedge and there was some motion around the wedge prior to removal. After the wedge was removed, there was some fibrous tissue at the osteotomy site. This was debrided with a rongeur and curette in order to remove all fibrous tissue down to bleeding bony surfaces. Once the osteotomy site was adequately debrided, the incision was irrigated. The Vitoss graft was used to pack into the osteotomy site. The osteotomy was closed down with a small penetrating bone clamp and fixated using a Stryker 4-hole titanium plate and 4 Stryker 2.3 mm cortical screws placed from dorsal to plantar over the osteotomy site. This provided secure fixation of the osteotomy site. This was visualized with fluoroscopy. Multiple fluoroscopic views were saved and printed, showing fixation of the osteotomy. The incision was again irrigated. The deep fascia was reapproximated with 2-0 Vicryl; subcutaneous structures reapproximated with 3-0 Vicryl; skin was closed with 4-0 Prolene in a horizontal mattress suture .....
Help with codes??? Still use 28320 w/ nonunion fx dx???
Thanks
Jamie