HELP :) Complex surgery with fractures

afryberger

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Location
Lebanon, PA
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27825-RT, 27781-LT, 27752-LT & 20692-50

Am i anywhere close to what should be billed for this service?? Any advice?? Am I missing anything??

PREOPERATIVE DIAGNOSIS:
Bilateral open tibia/fibular fractures.

POSTOPERATIVE DIAGNOSIS:
Bilateral open tibia/fibular fractures.

OPERATION:
Irrigation and debridement and application of external fixators to bilateral tibia
and fibular fractures.

ASSISTANT:

INDICATION FOR PROCEDURE:
Patient is a 48-year-old, Asian male, who was admitted to ********the after suffering bilateral lower extremity crush injuries with an I-beam
fell on both lower legs. He was brought to the ******. He was noticed to be bleeding from both lower extremities.
He had a grade I open left midshaft tibia/fibula fracture. On the right side, he
had a grade III B comminuted open right distal tibia/fibula pilon fracture. The
wounds were irrigated and splinted, and the patient was intubated and taken to the
ICU awaiting surgical intervention. I was unable there for performing a
neurovascular exam, but it has been previously determined that there was no
vascular compromise. There was no available family members, so to physician
consent (including Dr. **********) was obtained in order perform an emergency
I and D and application of bilateral external fixators.

ANESTHESIA:
General.

ANESTHESIOLOGIST:

FINDINGS:

PROCEDURE:
The patient was brought to the operating room, where he was properly identified
and where proper laterality was established. He was placed in the supine position
on the OR table already intubated as described earlier. He had general anesthesia
successfully induced. He had received IV antibiotics recently, so no IV
antibiotics were administered just prior to the procedures. Both lower
extremities were scrubbed and prepared and draped in usual sterile manner. " Time-
out was performed" we were cleared to proceed.

Right side was approached first. A large piece of devitalized bone was removed.
We thoroughly irrigated the wound with about 12 L of saline delivered via the jet
lavage. The tissues appeared macroscopically clean. Aerobic and anaerobic
cultures taken after irrigation. Laceration was repaired with multiple #3 nylon
retention sutures. We then placed 2 half pins from anterior to posterior in the
proximal tibia under C-arm guide. Following the confirmation of proper pin
positioning, we next placed 1 transfixing pin across the calcaneus. All pins were
placed via stab wound incisions. We then erected our frame and pulled
longitudinal traction to better align the fragments superficially. After we
satisfied with the overall alignment, we maximally tightened all connections and
final C-arm shots were taken. The incisions were dressed with Xeroform, sterile
gauze, and sterile Kling followed by an Ace wrap. We then turned our attention to
the left side.

As this was a grade 1, i.e. 1 cm laceration, the laceration was extended on both
sides to allow for more thorough irrigation. We utilized 4 L of saline solution.
After we irrigated, the wound was closed with 3-0 nylon sutures. We then erected
another frame on left leg similar to the frame applied on the right leg. This was
dressed in the identical manner as on the opposite side. Final C-arm shots were
also taken and the patient was transferred directly back to the ICU, still
intubated, and in stable condition.
 
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