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Old 02-01-2012, 03:42 AM
topaz218521 topaz218521 is offline
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Default Implant arthroplasty of the right second and third

Implant arthroplasty of the right second and third

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Can someone help me with this. I can' find a code for Implant arthroplasty of the right second and third metatarsophalangeal joints. I have attached the op note.

PREOPERATIVE DIAGNOSIS: Painful right second and third toes with
painful hardware of the right foot.

POSTOPERATIVE DIAGNOSIS: Painful right second and third toes
with painful hardware of the right foot.

OPERATIONS DONE:
1. Implant arthroplasty of the right second and third
metatarsophalangeal joints.
2. Hardware removal right foot.

SURGERY START TIME: As dictated in nurse's report.

SURGERY END TIME: As dictated in nurse's report.

TOURNIQUET INFLATED: As dictated in nurse's report.

TOURNIQUET DEFLATED: As dictated in nurse's report.

PATHOLOGY SENT: Hardware from the right foot.

MICROBIOLOGY SENT: None.

HARDWARE USED: Two Swanson lesser toe implants.

MATERIALS USED: 3-0 Vicryl suture, 4-0 Vicryl suture, 3-0 nylon
suture.

ANESTHESIA: Local with monitored anesthesia care.

INDICATIONS FOR SURGERY:
The patient is a 64-year-old white male that presented to the
clinic complaining of painful right foot. He states that his
right second and third toes are bothering him when he walks
causing him significant pain on range of motion.

Physical examination showed normal neurovascular status with pain
on palpation and range of motion to the second and third
metatarsophalangeal joints. Pain on palpation was also noted to
the right great toe and foot where previous hardware was
implanted.

At this time all surgical and conservative options were discussed
with the patient and he opted for surgical intervention. No
guarantees were given. Consent was signed under no coercion
after all risks and benefits were discussed in detail with the
patient.

DESCRIPTION OF PROCEDURE:
The patient was escorted to the Operating Room and placed on the
operating table in the supine position. The patient was then
given the above mentioned anesthesia. Pneumatic tourniquet was
placed at the level of the right ankle. The right foot was then
prepped and draped using aseptic sterile technique. The right
foot was then elevated and exsanguinated using Esmarch bandage
and the pneumatic tourniquet was increased to 250 mmHg and
remained for the time mentioned above.

Attention was then directed to the dorsal aspect of the right
first metatarsophalangeal joint where a previous surgical scar
was noted. The incision was made over the scar using sharp and
blunt dissection and paying careful attention to all
neurovascular structure. The incision was then deepened to the
level of the hardware which was identified and resected in toto
using power instrumentation. The hardware was then sent to
Pathology for analysis. The wound was irrigated and closed using
3-0 Vicryl suture for deep closure and 4-0 Vicryl suture for
subcutaneous closure and 3-0 nylon suture for skin closure.

Attention was then directed to the second and third
metatarsophalangeal joints where a 4 centimeter linear incision
between the two joints was performed. The incision was deepened
through the subcutaneous tissues paying careful attention to all
neurovascular structures. All bleeders were cauterized at this
time. The incision was deepened to the level of the
metatarsophalangeal joints which were identified and incised
linearly paying careful attention to the extensor digitorum
longus tendons. The joints were then exposed and resected in
toto using power instrumentation. The Swanson lesser toe
implants were then placed inside the second and third
metatarsophalangeal joints. Free range of motion was noted. The
wounds were irrigated with copious amounts of normal sterile
saline. Deep closure was performed using 3-0 Vicryl suture.
Subcutaneous closure was performed using 4-0 Vicryl suture and
skin closure was performed with 3-0 nylon suture.

The pneumatic tourniquet was released at this time and immediate
hyperemia to all toes was noted. The patient seemed to tolerate
the anesthesia and the procedure well as was escorted back to the
Recovery Room with vital signs stable and neurovascular status
intact.
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