Sara82
Guru
My Dr wants to charge 27654 x2. I dont know if that going to work and was looking for another opinion and to see if there was any other code that might work. Thanks so much in advance!
POSTOPERATIVE DIAGNOSIS:
Chronic left Achilles tendon rupture.
OPERATION PERFORMED:
1. Repair of chronic Achilles tendon rupture.
2. Turned-down flap augmentation of chronic left Achilles tendon
rupture repair.
We identified the sural nerve and this
was retracted laterally. We also identified the area of the
chronic tearing. Interposed in this tear, which was located
about 6 cm above the insertion into the calcaneus, there was
abundant scar tissue in around the area. We performed
debridement of the scar tissue. We identified the viable ends of
the tendon. We debrided back until we got good viable bleeding
by blunt and sharp dissection. Once we had established the
viable ends of the Achilles tendon, we were initially left with
about a 6 cm difference. We took a 2-0 Ethibond suture and we
performed a Bunnell type of weave through the more proximal
segment, and we then took the weave and the tendons and we pulled
gentle traction on this, allowed the Achilles tendon to come back
out to length. We digitally and manually were able to dissect
out adhesions to the paratenon higher up within this area. After
about 5 minutes of doing this, the gap was reduced down to about
2 cm. At that point, we were able to plantarflex the foot with
only mild levels and we were able to re-oppose the major segments
and we tied off the #2 Ethibond sutures, 1 being in the proximal
segment and then a second that we had placed in the distal
segment. Prior to doing this, we took a posterior midline
fascial band of about 1.5 to 2 cm and we left it hinged just
above the tear site and this fascial band was in the midline of
the proximal segment of the Achilles tendon. We took this band,
we elevated off the underlying muscle, and we closed this
interval with interrupted Ethibonds and absorbable sutures. This
free band that we had created was approximately about 10 cm long.
We then swiveled this band of tissue for transfer of this
turned-down flap. We sutured it down in place and then rotated
so that the glistening part of this tendon was exposed as part of
our repair, and then we essentially used this tendon as almost a
candy cane type of wrap around the repair site and then sutured
it proximally into the major tendon site and then distally into
the distal site, and then we sutured it down to overlying the
repair site to serve as augmentation. When we had completed
this, we stressed the Achilles tendon, had good stability to
stress examination. We augmented the repair with interrupted
absorbable and nonabsorbable sutures. After we completed again
we had a good stability of our repair with good tension on it.
POSTOPERATIVE DIAGNOSIS:
Chronic left Achilles tendon rupture.
OPERATION PERFORMED:
1. Repair of chronic Achilles tendon rupture.
2. Turned-down flap augmentation of chronic left Achilles tendon
rupture repair.
We identified the sural nerve and this
was retracted laterally. We also identified the area of the
chronic tearing. Interposed in this tear, which was located
about 6 cm above the insertion into the calcaneus, there was
abundant scar tissue in around the area. We performed
debridement of the scar tissue. We identified the viable ends of
the tendon. We debrided back until we got good viable bleeding
by blunt and sharp dissection. Once we had established the
viable ends of the Achilles tendon, we were initially left with
about a 6 cm difference. We took a 2-0 Ethibond suture and we
performed a Bunnell type of weave through the more proximal
segment, and we then took the weave and the tendons and we pulled
gentle traction on this, allowed the Achilles tendon to come back
out to length. We digitally and manually were able to dissect
out adhesions to the paratenon higher up within this area. After
about 5 minutes of doing this, the gap was reduced down to about
2 cm. At that point, we were able to plantarflex the foot with
only mild levels and we were able to re-oppose the major segments
and we tied off the #2 Ethibond sutures, 1 being in the proximal
segment and then a second that we had placed in the distal
segment. Prior to doing this, we took a posterior midline
fascial band of about 1.5 to 2 cm and we left it hinged just
above the tear site and this fascial band was in the midline of
the proximal segment of the Achilles tendon. We took this band,
we elevated off the underlying muscle, and we closed this
interval with interrupted Ethibonds and absorbable sutures. This
free band that we had created was approximately about 10 cm long.
We then swiveled this band of tissue for transfer of this
turned-down flap. We sutured it down in place and then rotated
so that the glistening part of this tendon was exposed as part of
our repair, and then we essentially used this tendon as almost a
candy cane type of wrap around the repair site and then sutured
it proximally into the major tendon site and then distally into
the distal site, and then we sutured it down to overlying the
repair site to serve as augmentation. When we had completed
this, we stressed the Achilles tendon, had good stability to
stress examination. We augmented the repair with interrupted
absorbable and nonabsorbable sutures. After we completed again
we had a good stability of our repair with good tension on it.