mindyanna
Networker
Hi,
I have a physician who does a fascia lateral release (or as he calls it; resection. I do not see any type of compartment syndrome as one of the diagnosis codes nor does the patient have any type of contracture going on. The way I read this note it appears it was basically something he did to gain access to where he wanted to be. The operative report is below. I typed it out as I saw it but left out a lot of verbage not pertaining to the operative session My question is this: Which fasciatomy code should I be looking at here? There is 27496, 27892, 27893 and 27305 but again, there is no mention of any compartment syndrome that needs to be released. What do you think? The other codes I have chosen for this case is 27466 and 64614. Since he does not leave the external fixator on I have not coded this and the insertion of the intramedullary skeletal kinetic device (ISKD) is a part of the 27466. What do you think???
Diagnosis: Ollier disease right femur, Leg length descrepancy 1.7 cm, right shorter than left.
1. Osteoplasty right femur for lengthening
2. Insertion of external fixation device right femur to control rotation (fixator-assisted nailing)
3. Insertion of intramedullary skeletal knetic device with internal limb lengthening nail, right femur
4. Fascia lateral release
5. Injection of botulinum toxin right rectus femoris
I made a 2 cm incision anteriorly in the distal thigh at the level of the superior pole of the patella. I dissected down to the fascia lata, identified it and then isolated it and transected it anteriorly to the level of the midline anteriorly and to the level of the intramuscular septum posteriorly. Next, I made a starting hole at the tip of the greater trochanter to insert the ISKD. I selected a tibial ISKD instead of a femoral ISKD due to the unusual anatomy to from proximal femur with a rather short neck. I checked the staring point on AP and lateral fluoroscopy with a K-wire, then made a 2.5 cm insertion incision, dissected down to the tip of the trochanter with a meostat and inserted a Steinmann pin into the proximal femur. I checked that position on AP and lateral fluoroscopic views and then reamed over it with an 8-mm ACL reamer. Here I inserted a beaded guidewire down the shaft of the femur. I then withdrew the beaded guidewire back to the level of the intended site of the osteotomy. I marked out the osteotomy site by calculating the length of the nail and then backing out by 12 cm for the intended osteotomy site. I then marked the skin, made a 1-cm incision laterally and dissected down to the bone with a hemostat. I elevated the periosteum anteriorly and posteriorly with a small periosteal elevator. I made several passes with a 4.8-mm drill bit, being careful to clean the drill bit after each pass, so that it would be nice and sharp and efficient. I then reinserted the beaded quidewire down to the end of the femur. I then began reaming, starting with the 8-mm size and going all the way up to 12.5 mm in diameter by 0.5 mm increments. At the end I reinserted an 11-mm reamer at the level of the lesser trochanter. I brought the C-arm into a lateral view and inserted a 1.8-mm wire into the lesser trochanter perpendicular to the shaft of the femur. I did this for rotational control. I inserted a 2nd half pin through the distal fascia lata incision, into the distal femur, parallel to the 1st pin proximally at the lesser trochanter. I then constructed a Jet-Ex external fixator to span these 2. I removed the Jet-Ex device and prepared the ISKD for insertion. I attached it to the jig and tested the proximal interlocking holes. I was not happy with it so I sapped out that nail for a second nail, which performed much better. I lengthened the nail so that there was approximately 17.5 mm of nail left inside for lenghtening. I then inserted the nail to the level of the osteotomy,completed the osteotomy with a 1/2 inch osteotome, reduced the fracture and passed the nail beyond it while maintaining control with the external fixator. I then reapplied the locking jig guide and inserted the proximal 2 interlocks. That went seamlessly, without difficulty. I used the 6.0-mm locking screws proximally. Distally for locking, I brought the C-arm to an AP position and made 2 incisions over the locking holes. I passed a 1.8-mm wire into each and then drilled over them with a 3.8-mm cannulated drill/router. I then inserted a 4-mm solid drill bit into the initial hole and passed it through the nail and out the posterior cortex. I inserted the 2 distal interlocks.
Next, I added the end cap proximally. I then disassembled the external fixator, marked the magnet at the level of the magnet from the nail on the skin with a skin marker and used the magnetic detector to obtain a reading. I then used the external fixation pins as paddles to make approximately 18 to 20 turns and then tested the magnetic detector again. I injected 100 units of Botx into the anterior rectus femoris prior to leaving the OR through the 5 separate injection ports and front of the thigh.
I have a physician who does a fascia lateral release (or as he calls it; resection. I do not see any type of compartment syndrome as one of the diagnosis codes nor does the patient have any type of contracture going on. The way I read this note it appears it was basically something he did to gain access to where he wanted to be. The operative report is below. I typed it out as I saw it but left out a lot of verbage not pertaining to the operative session My question is this: Which fasciatomy code should I be looking at here? There is 27496, 27892, 27893 and 27305 but again, there is no mention of any compartment syndrome that needs to be released. What do you think? The other codes I have chosen for this case is 27466 and 64614. Since he does not leave the external fixator on I have not coded this and the insertion of the intramedullary skeletal kinetic device (ISKD) is a part of the 27466. What do you think???
Diagnosis: Ollier disease right femur, Leg length descrepancy 1.7 cm, right shorter than left.
1. Osteoplasty right femur for lengthening
2. Insertion of external fixation device right femur to control rotation (fixator-assisted nailing)
3. Insertion of intramedullary skeletal knetic device with internal limb lengthening nail, right femur
4. Fascia lateral release
5. Injection of botulinum toxin right rectus femoris
I made a 2 cm incision anteriorly in the distal thigh at the level of the superior pole of the patella. I dissected down to the fascia lata, identified it and then isolated it and transected it anteriorly to the level of the midline anteriorly and to the level of the intramuscular septum posteriorly. Next, I made a starting hole at the tip of the greater trochanter to insert the ISKD. I selected a tibial ISKD instead of a femoral ISKD due to the unusual anatomy to from proximal femur with a rather short neck. I checked the staring point on AP and lateral fluoroscopy with a K-wire, then made a 2.5 cm insertion incision, dissected down to the tip of the trochanter with a meostat and inserted a Steinmann pin into the proximal femur. I checked that position on AP and lateral fluoroscopic views and then reamed over it with an 8-mm ACL reamer. Here I inserted a beaded guidewire down the shaft of the femur. I then withdrew the beaded guidewire back to the level of the intended site of the osteotomy. I marked out the osteotomy site by calculating the length of the nail and then backing out by 12 cm for the intended osteotomy site. I then marked the skin, made a 1-cm incision laterally and dissected down to the bone with a hemostat. I elevated the periosteum anteriorly and posteriorly with a small periosteal elevator. I made several passes with a 4.8-mm drill bit, being careful to clean the drill bit after each pass, so that it would be nice and sharp and efficient. I then reinserted the beaded quidewire down to the end of the femur. I then began reaming, starting with the 8-mm size and going all the way up to 12.5 mm in diameter by 0.5 mm increments. At the end I reinserted an 11-mm reamer at the level of the lesser trochanter. I brought the C-arm into a lateral view and inserted a 1.8-mm wire into the lesser trochanter perpendicular to the shaft of the femur. I did this for rotational control. I inserted a 2nd half pin through the distal fascia lata incision, into the distal femur, parallel to the 1st pin proximally at the lesser trochanter. I then constructed a Jet-Ex external fixator to span these 2. I removed the Jet-Ex device and prepared the ISKD for insertion. I attached it to the jig and tested the proximal interlocking holes. I was not happy with it so I sapped out that nail for a second nail, which performed much better. I lengthened the nail so that there was approximately 17.5 mm of nail left inside for lenghtening. I then inserted the nail to the level of the osteotomy,completed the osteotomy with a 1/2 inch osteotome, reduced the fracture and passed the nail beyond it while maintaining control with the external fixator. I then reapplied the locking jig guide and inserted the proximal 2 interlocks. That went seamlessly, without difficulty. I used the 6.0-mm locking screws proximally. Distally for locking, I brought the C-arm to an AP position and made 2 incisions over the locking holes. I passed a 1.8-mm wire into each and then drilled over them with a 3.8-mm cannulated drill/router. I then inserted a 4-mm solid drill bit into the initial hole and passed it through the nail and out the posterior cortex. I inserted the 2 distal interlocks.
Next, I added the end cap proximally. I then disassembled the external fixator, marked the magnet at the level of the magnet from the nail on the skin with a skin marker and used the magnetic detector to obtain a reading. I then used the external fixation pins as paddles to make approximately 18 to 20 turns and then tested the magnetic detector again. I injected 100 units of Botx into the anterior rectus femoris prior to leaving the OR through the 5 separate injection ports and front of the thigh.