I have been trying to research the coding for a procedure done in an ASC and everything I find seems like it is not specific enough. Can help me out with this one or point me to some material that would help me out? I would really appreciate it. Thank you!!
I have 27658, 27658-59, 27695.
A linear incision was created overlying the peroneus tendon, starting just inferior to the lateral malleolus, extending down to the calcaneocuboid joint. Upon entering the area, there was a significant amount of fatty infiltration of the peroneal tendon sheaths. The tendon sheaths were incised and there was minimal partial-thickness longitudinal tear of the peroneus longus tendon. The end rows of this tendon were debrided and also retubulized utilizing 4-0 nylon. As a side note, this was not seen or reported by the radiologist when she had her MRI performed a few weeks back.
Next, the peroneus brevis was inspected and noted to have a full-thickness split longitudinal tear along with thinning of the peroneus brevis tendon. Additionally, there was also a low-lying peroneus brevis muscle belly. The muscle belly extended down to the tip of the lateral malleolus. The muscle was debrided and taken just above the ankle joint, approximately 5 cm, and the ends of the tendon were debrided and retubulized utilizing 4-0 nylon. Due to the thin nature of this tendon, as well as the minor pathology that was seen intraoperatively, I elected to reinforce the repair utilize TissueMend, which was secured down to the peroneus brevis tendon utilizing 3-0 nylon.
The area was flushed with sterile saline mixed with Bacitracin solution. The peroneal tendon sheaths were recoapted utilizing 3-0 Vicryl. The retinaculum was repaired utilizing 2-0 Vicryl. The subcutaneous tissue was closed utilizing 3-0 Vicryl and the skin was closed and coapted utilizing 4-0 Monocryl in a running subcuticular suture technique.
Attention was then directed to the anterolateral ankle overlying the sinus tarsi where a small curvilinear incision was created overlying this area. Blunt dissection was created down through the deep tissue, taking care to retract and identify all vital neurovascular structures. All bleeders were cauterized as necessary. Upon entering the area, I incised the superficial peroneal retinaculum and there was no anterior talofibular ligament identified. I attempted to locate this ligament but there was some fraying of the tissue. At this time, the repair was continued and I utilized the Stryker SonicAnchor with #2 Force Fiber x3, which were inserted to the inferior portion of the lateral malleolus; one approximately 2 cm from the tip of the lateral malleolus, one 1 cm anterior to this, and the third one right in the center of these two. I then utilized a pants-over-vest technique to recoapt and repair the anterior talofibular ligament.
The area was flushed with sterile saline mixed with Bacitracin solution. The retinaculum was repaired utilizing 3-0 Vicryl. The subcutaneous tissue was closed and coapted utilizing 3-0 Vicryl. The skin was closed and coapted utilizing 4-0 Monocryl in a running subcuticular surgical technique. I reinforced the surgical incisions utilizing Mastisol and Steri-strips. I thenreinforced the incision with 0.5% Marcaine plain and also Kenalog 40 mg/dL. As I was suturing, the tourniquet had to be deflated due to the time allotted. Good hyperemic response of the soft tissue was noted, as well as the digits. The skin edges were nice and viable as well. A sterile semicompressive dressing was applied, consisting of Xeroform, Adaptic, 4x4 gauze, Kerlix and a 4-inch ACE bandage. A well-padded posterior splint was applied, and kept intact and in place with three 4-inch ACE bandages.
The patient was extubated by the anesthesiologist in the OR without any known complications. The patient was transported to the recovery room with stable vital signs and vascular status intact to the left foot.
I have 27658, 27658-59, 27695.
A linear incision was created overlying the peroneus tendon, starting just inferior to the lateral malleolus, extending down to the calcaneocuboid joint. Upon entering the area, there was a significant amount of fatty infiltration of the peroneal tendon sheaths. The tendon sheaths were incised and there was minimal partial-thickness longitudinal tear of the peroneus longus tendon. The end rows of this tendon were debrided and also retubulized utilizing 4-0 nylon. As a side note, this was not seen or reported by the radiologist when she had her MRI performed a few weeks back.
Next, the peroneus brevis was inspected and noted to have a full-thickness split longitudinal tear along with thinning of the peroneus brevis tendon. Additionally, there was also a low-lying peroneus brevis muscle belly. The muscle belly extended down to the tip of the lateral malleolus. The muscle was debrided and taken just above the ankle joint, approximately 5 cm, and the ends of the tendon were debrided and retubulized utilizing 4-0 nylon. Due to the thin nature of this tendon, as well as the minor pathology that was seen intraoperatively, I elected to reinforce the repair utilize TissueMend, which was secured down to the peroneus brevis tendon utilizing 3-0 nylon.
The area was flushed with sterile saline mixed with Bacitracin solution. The peroneal tendon sheaths were recoapted utilizing 3-0 Vicryl. The retinaculum was repaired utilizing 2-0 Vicryl. The subcutaneous tissue was closed utilizing 3-0 Vicryl and the skin was closed and coapted utilizing 4-0 Monocryl in a running subcuticular suture technique.
Attention was then directed to the anterolateral ankle overlying the sinus tarsi where a small curvilinear incision was created overlying this area. Blunt dissection was created down through the deep tissue, taking care to retract and identify all vital neurovascular structures. All bleeders were cauterized as necessary. Upon entering the area, I incised the superficial peroneal retinaculum and there was no anterior talofibular ligament identified. I attempted to locate this ligament but there was some fraying of the tissue. At this time, the repair was continued and I utilized the Stryker SonicAnchor with #2 Force Fiber x3, which were inserted to the inferior portion of the lateral malleolus; one approximately 2 cm from the tip of the lateral malleolus, one 1 cm anterior to this, and the third one right in the center of these two. I then utilized a pants-over-vest technique to recoapt and repair the anterior talofibular ligament.
The area was flushed with sterile saline mixed with Bacitracin solution. The retinaculum was repaired utilizing 3-0 Vicryl. The subcutaneous tissue was closed and coapted utilizing 3-0 Vicryl. The skin was closed and coapted utilizing 4-0 Monocryl in a running subcuticular surgical technique. I reinforced the surgical incisions utilizing Mastisol and Steri-strips. I thenreinforced the incision with 0.5% Marcaine plain and also Kenalog 40 mg/dL. As I was suturing, the tourniquet had to be deflated due to the time allotted. Good hyperemic response of the soft tissue was noted, as well as the digits. The skin edges were nice and viable as well. A sterile semicompressive dressing was applied, consisting of Xeroform, Adaptic, 4x4 gauze, Kerlix and a 4-inch ACE bandage. A well-padded posterior splint was applied, and kept intact and in place with three 4-inch ACE bandages.
The patient was extubated by the anesthesiologist in the OR without any known complications. The patient was transported to the recovery room with stable vital signs and vascular status intact to the left foot.