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I am leaning towards 27485, but am wondering if I should use modifier 52 since he doesnt remove anything from the growth plate?
Fluoroscopic guidance was used to position a 4- to 5-cm long
longitudinal incision on the right medial knee centered over the
distal femoral physis. The incision was carried sharply through skin
and subcutaneous tissue. The deep fascia was divided longitudinally.
Deep self-retaining retractor was placed. Keith needle was placed
within the physis. A 24-mm length OrthoPediatrics 8 plate was selected
and slid over the Keith needle, straddling the distal femoral physis.
Guidewires were drilled into the metaphysis and epiphysis with
position assessed on AP and lateral fluoroscopic images. The wires
were over drilled. Then 24-mm length cannulated screws were placed
over the guidewires into the metaphysis and epiphysis. Both screws had
excellent purchase in bone. Guidewires were removed. Final
fluoroscopic images were saved, demonstrating satisfactory plate
position and screw position and length.
The wound was irrigated with normal saline. Deep fascia was repaired
with running 2-0 Polysorb suture. Deep subcutaneous layer was closed
with interrupted 2-0 Polysorb suture. Superficial subcutaneous layer
and skin were closed with interrupted 3-0 Polysorb suture. Benzoin,
Steri-Strips and sterile dressings were applied. The tourniquet was
let down.
Fluoroscopic guidance was used to position a 4- to 5-cm long
longitudinal incision on the right medial knee centered over the
distal femoral physis. The incision was carried sharply through skin
and subcutaneous tissue. The deep fascia was divided longitudinally.
Deep self-retaining retractor was placed. Keith needle was placed
within the physis. A 24-mm length OrthoPediatrics 8 plate was selected
and slid over the Keith needle, straddling the distal femoral physis.
Guidewires were drilled into the metaphysis and epiphysis with
position assessed on AP and lateral fluoroscopic images. The wires
were over drilled. Then 24-mm length cannulated screws were placed
over the guidewires into the metaphysis and epiphysis. Both screws had
excellent purchase in bone. Guidewires were removed. Final
fluoroscopic images were saved, demonstrating satisfactory plate
position and screw position and length.
The wound was irrigated with normal saline. Deep fascia was repaired
with running 2-0 Polysorb suture. Deep subcutaneous layer was closed
with interrupted 2-0 Polysorb suture. Superficial subcutaneous layer
and skin were closed with interrupted 3-0 Polysorb suture. Benzoin,
Steri-Strips and sterile dressings were applied. The tourniquet was
let down.