I've been doing orthopedics for a few years but I am a little stumped on this one. I also didn't code anything for a while so maybe I'm a little rusty. But if someone could help me with this one I would be in their debt. I'm confused on the CPT for surgical procedure #3 below, the excision of medial malleolar fragment with advancement of the deltoid ligament, ankle.
PRE/POSTOPERATIVE DX: Trimalleolar fracture/dislocation left ankle
SURGICAL PROCEDURE:
1. ORIF trimalleolar fracture/dislocation with plate fixation of the fibula.
2. Reduction and fixation of the syndesmosis with syndesmosis screw.
3. Excision of the medial malleolar fragment with advancement of the deltoid ligament left ankle.
Concerning #3:
Attention was turned to the medial side. The medial side was opened and the medical malleolus was found to be comminuted to the point it could not be reconstructed. The periosteum had been protected as had the fascia and had been split longitudinally and the medical malleolar fragment was removed in toto. It was in about 4 pieces. This was copiously irrigated and the C-arm was used to visualize that there were no futher fragments that were significant. Attention was then turned back to the syndesmosis. The syndesmosis was reduced and held a 3.5 cortical screw 45, 3 cortices. Good position, good alignment, verified on all views. There was a little bit of laxity on the medial side. This was before the deltoid had been repaired. The wounds were copiously irrigated. On the medial side the deltoid was advanced through bone, sutures 0 Vicryl, and the periosteum and fascia clised over it and in a longitudinal fashion with 0 Vicryl running sutures.
PRE/POSTOPERATIVE DX: Trimalleolar fracture/dislocation left ankle
SURGICAL PROCEDURE:
1. ORIF trimalleolar fracture/dislocation with plate fixation of the fibula.
2. Reduction and fixation of the syndesmosis with syndesmosis screw.
3. Excision of the medial malleolar fragment with advancement of the deltoid ligament left ankle.
Concerning #3:
Attention was turned to the medial side. The medial side was opened and the medical malleolus was found to be comminuted to the point it could not be reconstructed. The periosteum had been protected as had the fascia and had been split longitudinally and the medical malleolar fragment was removed in toto. It was in about 4 pieces. This was copiously irrigated and the C-arm was used to visualize that there were no futher fragments that were significant. Attention was then turned back to the syndesmosis. The syndesmosis was reduced and held a 3.5 cortical screw 45, 3 cortices. Good position, good alignment, verified on all views. There was a little bit of laxity on the medial side. This was before the deltoid had been repaired. The wounds were copiously irrigated. On the medial side the deltoid was advanced through bone, sutures 0 Vicryl, and the periosteum and fascia clised over it and in a longitudinal fashion with 0 Vicryl running sutures.