Help Please - nonfriable tissues


Biloxi, MS
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It must be Monday:) I could use a little help. This patient is one month post op hind foot fusion. I am having a problem finding a removal/replacement code for the rod. So any thoughts would be appreciated.

The incision along the contour aspect was
extended distal and proximal. The wound edges were debrided. Subcutaneous
tissue were debrided back to nonfriable tissues. There was a medial abscess
that was unroofed and extended both proximally and distally. Purulent
drainage was noted along with bone particles. Next, the rod was identified in
the plantar aspect of the foot. The end cap was removed, and the targeting
device was then placed on the end of the rod. This was done using
fluoroscopic control. Next, the targeting device was used to remove the
calcaneal and talar screws, 2 lateral screws and 1 posterior. Next, the
proximal screws were also removed under fluoroscopic control. The
intramedullary guidewire was then put in place. The nail was then withdrawn.
A reduction tube was put into place to hold the alignment of the fusion. The
nail was cleaned on the back table with saline and bacitracin and then was
taken to the sterilizer to be flashed for 10 minutes. The screws were also
cleaned and flashed. Next, the wound and canal was then irrigated with normal
saline. The Pulsavac brush was then introduced into the canal, and it was
brushed and cleaned. It was reamed with a #12 reamer and irrigated again.
Once this was completed and the rod was ready, the rod was then put back into
place. It was advanced up through the calcaneus in order to compress at the
fusion site, was not locked proximally to allow impaction. The distal screws,
1 lateral to medial calcaneal, 1 lateral to medial talar screw were then put
back into place, and the posterior calcaneus screw was also put back into
place. The wound was irrigated again with another 3 liters of normal saline,
7 antibiotic beads were placed in the plantar aspect of the wound. The


Greater Pittsburgh
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How about a revision of previous sx....28725-78,22( for subtalar fusion in post op(78) and 22 for revision) bump up the charge for the revision. Also, 11981-51 for beads.
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