solocoder
Expert
Could I get some opinions on this, please? The doctor is insisting this is 27685, but the patient's problem is not in the ankle or leg. It is a contracted MTP joint, which I think would 28234 (foot or toe).
Attention was directed to the contracted foot joint affecting the dorsal aspect of the distal second metatarsal. Taut contracted tissue was palpated subcuticular at the region. A curvilinear in a lazy-S fashion was performed approximately 3.5 cm in length over the area. The incision was deepened via sharp and blunt dissection down to the level of the extensor digitorum longus leg tendon coursing at the area. Care was taken to retract all vital neurovascular structures medial and lateral. All superficial bleeders were ligated. An incision was made overlying the extensor tendon complex coursing in this region, Attention was directed to the severe contracture of tendinous structures coursing to the second digit overlying the second MPJ level. The extensor digitorum brevis tenotomy was preserved. The tendon sheath and paratenon were gently dissected along the course where Z-tendon lengthening procedure was planned for the extensor digitorum longus tendon. A A Z-tendon lengthening procedure was performed distal/proximal along the course of the extensor digitorum longus tendon. The paratenon and tendon sheath were carefully repaired at the site of the Z-tendon lengthening using 4-0 Polysorb. Excellent release of the contracture the joint was achieved.
Any thoughts are appreciated.
Attention was directed to the contracted foot joint affecting the dorsal aspect of the distal second metatarsal. Taut contracted tissue was palpated subcuticular at the region. A curvilinear in a lazy-S fashion was performed approximately 3.5 cm in length over the area. The incision was deepened via sharp and blunt dissection down to the level of the extensor digitorum longus leg tendon coursing at the area. Care was taken to retract all vital neurovascular structures medial and lateral. All superficial bleeders were ligated. An incision was made overlying the extensor tendon complex coursing in this region, Attention was directed to the severe contracture of tendinous structures coursing to the second digit overlying the second MPJ level. The extensor digitorum brevis tenotomy was preserved. The tendon sheath and paratenon were gently dissected along the course where Z-tendon lengthening procedure was planned for the extensor digitorum longus tendon. A A Z-tendon lengthening procedure was performed distal/proximal along the course of the extensor digitorum longus tendon. The paratenon and tendon sheath were carefully repaired at the site of the Z-tendon lengthening using 4-0 Polysorb. Excellent release of the contracture the joint was achieved.
Any thoughts are appreciated.