lenamarie73
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Op report below. Doc wants to bill 27295 (Disarticulation of hip) again but the patient just had this done the day before. This reads to me as a debridement but the area is HUGE! 
A 49-year-old male, who was transferred to our institution after being placed on ECMO due to a clot that resulted after he had an Achilles tendon repair. This resulted in a dysvascular left lower extremity. He had a knee dislocation previously; however, the entire left leg was dead and he had been taken to the operating room previously for a left hip disarticulation. After disarticulation, apparently there was significant bleeding in the ICU. The Orthopedic Team was consulted to aid postoperatively with significant concern about managing his hemodynamic instability. The patient was on multiple pressors as he was bleeding through his dressings. The patient was made a now case and brought to the operating room. Dr. from Vascular was also involved.
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OPERATIVE DETAILS: The patient was taken to the operating room, where he surrendered to anesthesia. The left lower extremity had dressings removed and there was clearly bleeding from the limb. The limb was prepped and draped in a sterile fashion.
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Once the limb was prepped and draped, the flaps were opened up and the sutures that were there previously were removed. The beads that were there were removed. Then, an aggressive debridement was performed including removing multiple muscular compartments. The area of debridement was significant - the posterior flap of tissue measured over 12 inches from end to acetabulum, similar to the anterior flap. The beads were also removed. A medial incision was made that measured over 9 inches. This allowed access to the vessels medially. The vessels were tied off by Dr.. Once the muscle was adequately debrided with a knife down to the acetabulum, the acetabulum was also debrided and all bleeding was adequately controlled as much as possible using suture ligature as well as Bovie. The overall surface area that was debrided measured over 144 square inches.
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Once this was done, the entire limb was thoroughly irrigated with saline. Antibiotic beads were then placed into the dead space and the limb was loosely reapproximated. The patient was then taken back to the ICU in a relatively unchanged condition after having the left lower extremity dressed up.
Any help would be appreciated!
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A 49-year-old male, who was transferred to our institution after being placed on ECMO due to a clot that resulted after he had an Achilles tendon repair. This resulted in a dysvascular left lower extremity. He had a knee dislocation previously; however, the entire left leg was dead and he had been taken to the operating room previously for a left hip disarticulation. After disarticulation, apparently there was significant bleeding in the ICU. The Orthopedic Team was consulted to aid postoperatively with significant concern about managing his hemodynamic instability. The patient was on multiple pressors as he was bleeding through his dressings. The patient was made a now case and brought to the operating room. Dr. from Vascular was also involved.
*
OPERATIVE DETAILS: The patient was taken to the operating room, where he surrendered to anesthesia. The left lower extremity had dressings removed and there was clearly bleeding from the limb. The limb was prepped and draped in a sterile fashion.
*
Once the limb was prepped and draped, the flaps were opened up and the sutures that were there previously were removed. The beads that were there were removed. Then, an aggressive debridement was performed including removing multiple muscular compartments. The area of debridement was significant - the posterior flap of tissue measured over 12 inches from end to acetabulum, similar to the anterior flap. The beads were also removed. A medial incision was made that measured over 9 inches. This allowed access to the vessels medially. The vessels were tied off by Dr.. Once the muscle was adequately debrided with a knife down to the acetabulum, the acetabulum was also debrided and all bleeding was adequately controlled as much as possible using suture ligature as well as Bovie. The overall surface area that was debrided measured over 144 square inches.
*
Once this was done, the entire limb was thoroughly irrigated with saline. Antibiotic beads were then placed into the dead space and the limb was loosely reapproximated. The patient was then taken back to the ICU in a relatively unchanged condition after having the left lower extremity dressed up.
Any help would be appreciated!
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