Need help, please! Excision or biopsy?

solocoder

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Trying this one in another forum. I could really use some advice. Would you bill this as a biopsy, or excision?


The note for the consult prior to SX says: triphase bone scan performed on 12/29/16 showed osteomyelitis of the right midfoot, and I believe bone biopsy of the right 5th metatarsal stump to rule out osteomyelitis is reasonable. I do not believe he requires resection of the 4th & 5th metatarsal stumps and debridement of cuboid at this time.
However, if the bone biopsy shows osteomyelitis and pathogens are isolated, he may require return to surgery for resection of the 4th & 5th metatarsal stumps and debridement of cuboid.

The next day he does the surgery, calls it a "debridement" of bone, with a pre-op and post-op DX of "osteomyelitis". Path report says no osteomyelitis.

Meat of the SX note: By using a power sagittal saw, the 5th metatarsal base tuberosity and lateral aspect of the 5th metatarsal stump are removed from the lateral aspect of the metatarsal and passed off the table. The removed bone is sent to Microbiology for cultures and sensitivities, and it is to be sent to Pathology. The areas are rasped smooth and flushed with sterile saline solution. The capsular and periosteal structures are reapproximated using #3-0 Polysorb suture in a simple interrupted fashion.

Appreciate any thoughts.
 
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