Khighlund
New
So, I am coding this surgery below, and I need a little modifier help. I have come up with 27829 and 27814 together. How would you bill this out?
Thank you for any help you can give me.
PREOPERATIVE DIAGNOSIS:
1. Left displaced bimalleolar ankle fracture.
2. Left distal tibiofibular joint syndesmotic dislocation.
POSTOPERATIVE DIAGNOSIS:
1. Left displaced bimalleolar ankle fracture.
2. Left distal tibiofibular joint syndesmotic dislocation.
OPERATION PERFORMED:
1. Open reduction and internal fixation of left displaced bimalleolar ankle
fracture.
2. Open reduction and internal fixation of left distal tibiofibular joint
syndesmotic dislocation.
SURGICAL IMPLANT: Synthes distal fibula locking plate, 5-hole length,
multiple screws, syndesmotic screw which is 4.0 cortex, length 52 mm. There
is no necessity for medial malleolus fixation.
OPERATIVE INDICATIONS: A stress view was done, but it was
slightly over rotated and difficult to definitively tell if there was
widening, but you could see that the fibula has significant translation on
the medial clear space despite overlap looks wide. Pros and cons were
discussed for operative intervention. The patient has elected to proceed
after understanding risks and benefits for a bimalleolar ankle fracture
pattern including a small medial malleolus avulsion fracture.
OPERATIVE SUMMARY: The patient was brought in the operating suite, placed
supine on the operating room table. Following successful anesthetic, the
left lower extremity underwent sterile prep and drape after the tourniquet
being placed on the upper thigh. After prep and drape, I confirmed site of
operation with staff as well as antibiotic delivery. The incision was made
down through skin and subcutaneous tissues on the lateral aspect of the
ankle. Deep dissection proceeded down to the level of the fibula distally.
Proximally, the soft tissues were dissected carefully and I found the
superficial peroneal nerve was identified and protected. It was visualized.
Hohmann retractors were placed around the fibula and the fracture site was
exposed. The fracture site underwent subperiosteal elevation along its
margins. It was gapped open, cleaned of intervening debris and irrigated.
The fracture was then clamped together. An interfragmentary compression lag
screw was placed to compress. A 5-hole plate was selected, pinned into
position. Cortical screws used to compress plate to bone, locking screws
were placed where I felt advantageous. Next, I assessed the medial
malleolus fracture avulsion. It nicely realigned on the medial side. It is
a small caliber and in my opinion does not require any additional fixation
or open reduction, etc. Stress external rotation still produces widening of
the medial clear space and some loss of tib-fib overlap with stress external
rotation and abduction despite plating. The syndesmosis was deemed unstable
and required fixation. Under direct visualization, the syndesmosis was
reduced and confirmed radiographically. Happy with this, I then used a 2.9
drill to create a hole that was quadricortical in nature between fibula and
tibia. Measurements for length were taken. A 52 mm screw was placed.
Next, I proceeded with the final irrigation. I stressed the ankle again and
found it was stable with no widening on stressing at this point.
Layered closure was done at the end of the surgical
procedure and a warm, well-perfused foot was confirmed after the tourniquet
was let down. A short leg 3-way plaster splint was applied with the foot in
neutral position. The patient will follow up in the Institute in approximately 2 weeks.
Thank you for any help you can give me.
PREOPERATIVE DIAGNOSIS:
1. Left displaced bimalleolar ankle fracture.
2. Left distal tibiofibular joint syndesmotic dislocation.
POSTOPERATIVE DIAGNOSIS:
1. Left displaced bimalleolar ankle fracture.
2. Left distal tibiofibular joint syndesmotic dislocation.
OPERATION PERFORMED:
1. Open reduction and internal fixation of left displaced bimalleolar ankle
fracture.
2. Open reduction and internal fixation of left distal tibiofibular joint
syndesmotic dislocation.
SURGICAL IMPLANT: Synthes distal fibula locking plate, 5-hole length,
multiple screws, syndesmotic screw which is 4.0 cortex, length 52 mm. There
is no necessity for medial malleolus fixation.
OPERATIVE INDICATIONS: A stress view was done, but it was
slightly over rotated and difficult to definitively tell if there was
widening, but you could see that the fibula has significant translation on
the medial clear space despite overlap looks wide. Pros and cons were
discussed for operative intervention. The patient has elected to proceed
after understanding risks and benefits for a bimalleolar ankle fracture
pattern including a small medial malleolus avulsion fracture.
OPERATIVE SUMMARY: The patient was brought in the operating suite, placed
supine on the operating room table. Following successful anesthetic, the
left lower extremity underwent sterile prep and drape after the tourniquet
being placed on the upper thigh. After prep and drape, I confirmed site of
operation with staff as well as antibiotic delivery. The incision was made
down through skin and subcutaneous tissues on the lateral aspect of the
ankle. Deep dissection proceeded down to the level of the fibula distally.
Proximally, the soft tissues were dissected carefully and I found the
superficial peroneal nerve was identified and protected. It was visualized.
Hohmann retractors were placed around the fibula and the fracture site was
exposed. The fracture site underwent subperiosteal elevation along its
margins. It was gapped open, cleaned of intervening debris and irrigated.
The fracture was then clamped together. An interfragmentary compression lag
screw was placed to compress. A 5-hole plate was selected, pinned into
position. Cortical screws used to compress plate to bone, locking screws
were placed where I felt advantageous. Next, I assessed the medial
malleolus fracture avulsion. It nicely realigned on the medial side. It is
a small caliber and in my opinion does not require any additional fixation
or open reduction, etc. Stress external rotation still produces widening of
the medial clear space and some loss of tib-fib overlap with stress external
rotation and abduction despite plating. The syndesmosis was deemed unstable
and required fixation. Under direct visualization, the syndesmosis was
reduced and confirmed radiographically. Happy with this, I then used a 2.9
drill to create a hole that was quadricortical in nature between fibula and
tibia. Measurements for length were taken. A 52 mm screw was placed.
Next, I proceeded with the final irrigation. I stressed the ankle again and
found it was stable with no widening on stressing at this point.
Layered closure was done at the end of the surgical
procedure and a warm, well-perfused foot was confirmed after the tourniquet
was let down. A short leg 3-way plaster splint was applied with the foot in
neutral position. The patient will follow up in the Institute in approximately 2 weeks.