Can anyone give me your opinion on what codes to use for this

Bobby A

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Pre-op Diagnosis:  1. Left zygomaticomaxillary complex fracture 2. Left comminuted orbital fractures involving the lateral orbital wall, orbital floor, and inferomedial strut.
Post-op Diagnosis:  Unchanged
Procedure Performed:  1. Left zygomaticomaxillary complex fracture open reduction internal fixation with titanium plates 2. Left orbital fractures repair by open reduction with 0.35 mm nylon mesh implant
Specimen: No

Incision Closure: Deep and Superficial Layers

HISTORY/INDICATIONS

a 22-year-old male who collided with another player while playing basketball earlier this week.  He has suffered significant swelling pain and V2 anesthesia of the face.  CT examination in the emergency room revealed left-sided facial fractures involving the maxillary sinus, left orbit, and left tripod.  Risks benefits alternatives to surgical open reduction internal fixation of fractures were discussed.  The patient had pain with certain positions of gaze as well as trismus on examination.  He wished to proceed with surgery to correct his fractures.

DESCRIPTION OF PROCEDURE:

Patient was met in the preop holding area the left face was deemed to be the correct operative site level marked as such.  Patient was escorted to the operating room placed supine position on operating room table.  Time-out was performed.  General anesthesia was induced.  Local anesthetic was injected over the surgical site.  Patient was then prepped and draped in typical fashion for sterile oculoplastic surgery.  Corneal protectors were placed in both eyes.​

A 15. Bard-Parker blade incision was created along the left lateral canthus extending 1 cm laterally.  Sharp dissection was carried down the lateral orbital rim periosteum.  The in.  Inferior and superior crura were isolated and severed by sharp dissection.  Bovie electro cauterization was used to open the periosteum.  Periosteal elevator was used to expose the entire aspect of the lateral orbital wall.  Comminuted fracture of the inferolateral portion of the lateral wall as well as along the frontozygomatic suture line were identified and cleaned.

Next the lower eyelid was everted and a transconjunctival incision created 4 mm inferior to the tarsal border through the inferior retractor layer.  Great care was taken to stay in a pre sharp dissection was carried down this preseptal plane down to the inferior orbital rim until the entire lower reduce the contents of the orbit under direct visualization until all of the orbital contents had been retrieved from the maxillary sinus.  The bone was elevated using a Kocher hemostat into position and a 0.35 mm nylon mesh super foil implant cut to precisely cover the defect and laid into the subperiosteal space.  It clicked into position with no entrapment of residual tissue beneath it.

Next attention was turned to the plating.  To curvilinear plates an L-plate were used to fixate the bone along the lateral orbital rim, inferior orbital rim, and superior maxillary face.  4 mm screws were used.  A combination of 0.5 mm in 0.4 mm plates were used.  Once all the bones were in proper position all the incisions were closed.  A 5-0 plain gut suture was used in simple interrupted fashion to reapproximate the conjunctiva.  The lateral canthal tendon superior and inferior crus were reapproximated using a 5-0 Vicryl suture to the periosteum lateral orbital rim.  Periosteum was redraped over all of the plates and secured using buried interrupted 5-0 Vicryl sutures.  Skin was a flap laterally was reentered to the external lateral orbital rim periosteum using a buried interrupted 5-0 Vicryl suture.  The skin was reapproximated using a running 5-0 fast-absorbing plain gut suture.  The corneal protectors removed and antibiotic ointment applied to all incision sites and the left eye.  The lids were in proper position and palpation of the facial bones revealed good symmetry and coverage without palpable step-offs.
 
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