codedog
True Blue
doc office said to use 11420 , my office manager thinks this is 28043 -excision of soft tissue subcutaneous- I want to say this is 28092- what do you think
POSTOPERATIVE DIAGNOSIS: Soft tissue mass, right hallux.
OPERATION: Excision of soft tissue mass, right hallux.
SPECIMEN: Soft tissue mass.
ANESTHESIA: MAC with local.
TOURNIQUET: Right ankle at 250 mmHg.
TOURNIQUET TIME: 10 minutes.
ESTIMATED BLOOD LOSS: Less than 5 cc.
DRAINS: None.
PROSTHETIC MATERIAL: None.
COMPLICATIONS: None.
INDICATIONS FOR SURGERY: -year-old who suffers with a painful soft tissue mass involving the interphalangeal joint of his right great toe. An attempt was made in the office to aspirate this with cortisone injection. Despite treatment, the lesion continued and remained painful with any clothes and shoes. It was therefore recommended that he go forward with surgical excision. This procedure was explained to him in detail including associated risks, benefits and complications. The patient understands the possible risks that would include, but not limited to, pain, return of deformity, nerve or tendon damage, scar, bleeding, joint stiffness, gangrene, amputation, and death. The patient understands. He consented at this time. No guarantee was given.
PROCEDURE IN DETAIL:
The patient was taken to the operating room in a mildly sedated state and was placed on the operating table in the supine position. Following IV sedation, local anesthesia was obtained to the right hallux in a digital block using 10 cc of 1:100,000 mixture of 1% lidocaine plain and 0.25% Marcaine plain. Right lower extremity was scrubbed, prepped and draped in the usual aseptic technique. Using the Esmarch bandage, the right foot was exsanguinated and the tourniquet was inflated to 250 mmHg.
Attention was directed to the right hallux where at the interphalangeal joint, a palpable, subepidermal, nonpigmented soft tissue mass was noted. A 2 cm linear incision was made along the interphalangeal joint.
This incision was deepened through the subcutaneous tissue. Care was taken to identify and retract all neurovascular structures. All bleeders were cauterized as necessary. A well-encapsulated soft tissue mass was encountered. This was carefully dissected free of its underlying attachments. This continued into the joint capsule. The joint capsule was then incised and extensions were noted to the interphalangeal joints. Further dissection was performed until the mass was freed. This was passed from the operative field, sent for histopathology. Surgical site was thoroughly irrigated with copiously amounts of normal sterile saline. The joint capsule was reapproximated with a 3-0 Vicryl. Subcutaneous tissue was repaired with 3-0 Vicryl and the skin was reapproximated and coapted with a 4-0 nylon in simple suture technique. The tourniquet was released and a prompt hyperemic response was noted to the right foot. The incision was covered with Bactroban, Xeroform and a dry dressing of 4x4s and Kling. The patient tolerated the anesthesia and procedure well. He was transferred from the operating room to the recovery room with vital signs stable and intact.
npowccpath came back as fibroma of tendon sheath
POSTOPERATIVE DIAGNOSIS: Soft tissue mass, right hallux.
OPERATION: Excision of soft tissue mass, right hallux.
SPECIMEN: Soft tissue mass.
ANESTHESIA: MAC with local.
TOURNIQUET: Right ankle at 250 mmHg.
TOURNIQUET TIME: 10 minutes.
ESTIMATED BLOOD LOSS: Less than 5 cc.
DRAINS: None.
PROSTHETIC MATERIAL: None.
COMPLICATIONS: None.
INDICATIONS FOR SURGERY: -year-old who suffers with a painful soft tissue mass involving the interphalangeal joint of his right great toe. An attempt was made in the office to aspirate this with cortisone injection. Despite treatment, the lesion continued and remained painful with any clothes and shoes. It was therefore recommended that he go forward with surgical excision. This procedure was explained to him in detail including associated risks, benefits and complications. The patient understands the possible risks that would include, but not limited to, pain, return of deformity, nerve or tendon damage, scar, bleeding, joint stiffness, gangrene, amputation, and death. The patient understands. He consented at this time. No guarantee was given.
PROCEDURE IN DETAIL:
The patient was taken to the operating room in a mildly sedated state and was placed on the operating table in the supine position. Following IV sedation, local anesthesia was obtained to the right hallux in a digital block using 10 cc of 1:100,000 mixture of 1% lidocaine plain and 0.25% Marcaine plain. Right lower extremity was scrubbed, prepped and draped in the usual aseptic technique. Using the Esmarch bandage, the right foot was exsanguinated and the tourniquet was inflated to 250 mmHg.
Attention was directed to the right hallux where at the interphalangeal joint, a palpable, subepidermal, nonpigmented soft tissue mass was noted. A 2 cm linear incision was made along the interphalangeal joint.
This incision was deepened through the subcutaneous tissue. Care was taken to identify and retract all neurovascular structures. All bleeders were cauterized as necessary. A well-encapsulated soft tissue mass was encountered. This was carefully dissected free of its underlying attachments. This continued into the joint capsule. The joint capsule was then incised and extensions were noted to the interphalangeal joints. Further dissection was performed until the mass was freed. This was passed from the operative field, sent for histopathology. Surgical site was thoroughly irrigated with copiously amounts of normal sterile saline. The joint capsule was reapproximated with a 3-0 Vicryl. Subcutaneous tissue was repaired with 3-0 Vicryl and the skin was reapproximated and coapted with a 4-0 nylon in simple suture technique. The tourniquet was released and a prompt hyperemic response was noted to the right foot. The incision was covered with Bactroban, Xeroform and a dry dressing of 4x4s and Kling. The patient tolerated the anesthesia and procedure well. He was transferred from the operating room to the recovery room with vital signs stable and intact.
npowccpath came back as fibroma of tendon sheath