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Bundling Question 28415 & 28020

jenpollock

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One of our surgeons performed both 28415 & 28020 and I'm curious if the 28020 would be bundled with the 28415 even though it was performed in the subtalar joint?
**********************************
INTRAOPERATIVE FINDINGS:
Anatomically reduced subtalar joint, restored critical angles.

INDICATIONS:
This is a gentleman with interarticular calcaneus fracture who
now presents for surgical care with full understanding of the
risks, benefits and alternatives.

DESCRIPTION OF PROCEDURE:
The patient received preoperative antibiotics. After induction of
adequate anesthesia, the left lower extremity was prepared in the
usual sterile fashion after positioning in the lateral position
with a beanbag. The tourniquet was inflated after exsanguination
and L-shaped incision for extensile approach to the calcaneus was
utilized. The lateral wall was decorticated and the articular
surface was evident within the body of calcaneus and reflected in
order to allow for mobilization and for reduction to the medial
wall. The joint was effectively elevated and critical angles of
Bohler and Gissane were re-created using fluoroscopy. The
largest articular posterior facet fragments were lagged together
using a partially threaded screw followed by a neutralization
plate with an Ace calcaneal plate. The patient was a little bit
between sizes, so a smaller one was placed and screws were placed
divergently. The wound was then copiously irrigated and closed
in layers. All bone material that was removed during the course
of surgery was placed into the central void as well as the
lateral wall was closed on top of the void. The patient's wound
was copiously irrigated and closed in layers followed by bulky
soft dressing and stirrup splint.

CONDITION AT COMPLETION OF PROCEDURE:
The patient tolerated the procedure well. There were no
intraoperative complications.

NOTE:
Of note, during the exploration of the subtalar joint, articular
and bone fragments were noted to be loose bodies and were
removed.

NEEDLE AND SPONGE COUNTS:
All needle and sponge counts were correct.

DISPOSITION:
To the Recovery Room in stable condition.

IMPLANTS:
Ace calcaneal plate with assorted screws from small fragment set.
*****************************************************

Thank you, I would appreciate anyone's opinion.:)
 

mbort

True Blue
Messages
2,338
Location
ENGLEWOOD/DENVER
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my two cents: yes it bundles.

why I think so: sounds as if he accessed the calcaneous through the subtalar joint, while he was there he removed the loose bodies.

Hope this helps
Mary
 
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