Wiki Currettage of osteochondral lesion


Garfield, NJ
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I want to use CPT 29891 but not sure if there's anything else here I should be billing for?

DX: Osteochondral lesion medial aspect of right talus

Procedure: Curettage of osteochondral lesion along with application of natural tissue graft, wide human articular cartilage by the ABC company.

Ms. is a 41 year old female who presents to the Center with a chief complaint of a painful osteochondral lesion had been concerned by imaging studies of the posteromedial aspect of the patient's talar dome of the right foot.

The patient is complaining of pain around the ankle most pronounced when ambulating. The patient has been under the conservative care with Dr. K, but is no longer receiving adequate relief with conservative measures and at this point in time opts for surgical management of the condition with full understanding of the alternatives, risks, benefits, and potential complications of surgery and consents to such at this time.

The patient was taken into the operating room and placed on the operating room table in the supine position. The pneumatic ankle tourniquet was then placed about the patient's right thigh over adequate Webril padding, but not inflated at this time. After adequate IV sedation, a total of 30 cc of 0.5% Marcaine plain was infiltrated into the patient's right ankle in an ankle block technique. The foot and ankle were then scrubbed, prepped, and draped in the usual aseptic manner. An Esmarch bandage was then utilized to exsanguinate the patient's right front ankle and the pneumatic thigh tourniquet was inflated to 350 mmHg at this time. Attention was then directed to the posteromedial aspect of the right ankle, where an approximately 4 cm linear longitudinal incision was made starting at the medial aspect of the distal tibia and carried distally over the ankle joint. The incision was then deepened down to the level of bone. Care was taken to retract all vital and neurovascular structures. The periosteal and capsular structures were then carefully dissected free of their osseous attachments and reflected medially and laterally exposing the talar dome at the level of the ankle joint. The talar dome was then thoroughly inspected and the posteromedial aspect of the talar dome. A osteochondral defect approximately 1 cm in diameter was noted. This defect was then curettaged out with the removed lesion sent off the pathology for analysis. Next, the piece of the osteochondral defect was curetted with fibrin. Next, the defect was carefully filled with the Zimmer wide human articular cartilage skin graft. Time was then allowed for the fibrin along with the cartilaginous graft to set on top of this. Next another layer of the fibrin injectable was applied again time was given for the graft to set. Upon adequate time setting, the periosteal, capsular, and subcutaneous tissues were re approximated using a combination of 2 0 Vicryl and 3 0 Vicryl in a simple interrupted technique and the skin was then re approximated using 4 0 nylon in a simple interrupted manner as well. The incision site was dressed with Betadine-soaked Adaptic, Betadine-soaked gauze, sterile gauze, Kling, and a posterior splint. The pneumatic thigh tourniquet was deflated at this time for a total of 115 minutes up on the patient's right limb and immediate hyperemia was noted to all digits of the right foot. The patient tolerated both the procedure and the anesthesia well and was transferred from the operating room to the recovery room with vital signs stable and neurovascular status intact by member of the surgery and the anesthesia team.