PREOPERATIVE DIAGNOSIS: Exostosis of proximal phalanx, right foot.
POSTOPERATIVE DIAGNOSIS: Exostosis of proximal phalanx, right foot.
PROCEDURE PERFORMED: Exostectomy of base of proximal phalanx, right foot.
PATHOLOGY: First metatarsal bone, proximal phalanx bone, right foot. Aerobic and anaerobic cultures of first metatarsal as well as proximal phalanx.
DESCRIPTION OF PROCEDURE: The patient was seen in the preoperative waiting room where the correct procedure and site were identified. The patient brought into the operating room and placed on the operating table in the supine position. Sedation was achieved via IV medication. Anesthesia to the surgical site was achieved with local injection consisting of 10 mL of a 1:1 mixture of 0.5% Marcaine plain and 1% lidocaine plain. A well-padded pneumatic tourniquet was placed around the right ankle. The right foot was scrubbed, prepped, and draped in the usual aseptic manner. The right ankle was exsanguinated with an Esmarch bandage and the pneumatic tourniquet was inflated to 250 mmHg.
Procedure #1: Exostectomy of base of proximal phalanx, right foot:
With the use of a #15 blade, a 6-cm semi elliptical incision was made over the dorsomedial aspect of the right foot encompassing the scar tissue as well as the dorsal ulceration. The incision was placed medial to the extensor hallucis longus tendon, followed the apex of the deformity, it was located over the first metatarsophalangeal joint. All neurovascular structures were retracted medially and laterally and all bleeders were cauterized or ligated as deemed necessary.
With sharp and blunt dissection, incision was carried through the subcutaneous tissue, separating them from the deeper underlying structures. With the use of #15 blade, a linear capsulotomy was performed at the level of the first metatarsophalangeal joint. The capsule and periosteal tissue were retracted medially and laterally to allow for good visualization of the first metatarsophalangeal joint as well as the base of the proximal phalanx. A sagittal bone saw was then used to resect the medial and lateral condyle of the proximal phalanx of the hallux. Attention was then directed towards the first metatarsal, where the periosteal tissue was retracted and a rongeur was used to take a bone biopsy of the first metatarsal head as well specimen for aerobic and anaerobic cultures. At this time, the attention was then directed towards the base of the proximal phalanx, where again the bone rongeurs were used to take a bone biopsy as well as aerobic and anaerobic tissue culture specimen. At this time, with the use of a bone graft, the first metatarsal head and shaft were smoothed as well as the medial and lateral aspect of the proximal phalanx. The wound was then flushed with copious amounts of sterile saline. The capsule and deep tissue were reapproximated with the use of 3-0 Vicryl, the subcutaneous tissue was reapproximated using 4-0 Vicryl, and the skin was closed using interrupted horizontal mattress stitch of 4-0 Prolene. The surgical site was then dressed with Betadine-soaked Adaptic, 4x4 gauze, Kerlix, and Ace wrap. The patient tolerated the procedure and anesthesia well. The patient was transferred to the recovery room with vital signs stable and vascular status intact
Dr. office sent over 28124. Culture shows MRSA. I've asked two different coders and they are as perplexed as I am. This is a Medicare pt. Any help is greatly appreciated!!!
POSTOPERATIVE DIAGNOSIS: Exostosis of proximal phalanx, right foot.
PROCEDURE PERFORMED: Exostectomy of base of proximal phalanx, right foot.
PATHOLOGY: First metatarsal bone, proximal phalanx bone, right foot. Aerobic and anaerobic cultures of first metatarsal as well as proximal phalanx.
DESCRIPTION OF PROCEDURE: The patient was seen in the preoperative waiting room where the correct procedure and site were identified. The patient brought into the operating room and placed on the operating table in the supine position. Sedation was achieved via IV medication. Anesthesia to the surgical site was achieved with local injection consisting of 10 mL of a 1:1 mixture of 0.5% Marcaine plain and 1% lidocaine plain. A well-padded pneumatic tourniquet was placed around the right ankle. The right foot was scrubbed, prepped, and draped in the usual aseptic manner. The right ankle was exsanguinated with an Esmarch bandage and the pneumatic tourniquet was inflated to 250 mmHg.
Procedure #1: Exostectomy of base of proximal phalanx, right foot:
With the use of a #15 blade, a 6-cm semi elliptical incision was made over the dorsomedial aspect of the right foot encompassing the scar tissue as well as the dorsal ulceration. The incision was placed medial to the extensor hallucis longus tendon, followed the apex of the deformity, it was located over the first metatarsophalangeal joint. All neurovascular structures were retracted medially and laterally and all bleeders were cauterized or ligated as deemed necessary.
With sharp and blunt dissection, incision was carried through the subcutaneous tissue, separating them from the deeper underlying structures. With the use of #15 blade, a linear capsulotomy was performed at the level of the first metatarsophalangeal joint. The capsule and periosteal tissue were retracted medially and laterally to allow for good visualization of the first metatarsophalangeal joint as well as the base of the proximal phalanx. A sagittal bone saw was then used to resect the medial and lateral condyle of the proximal phalanx of the hallux. Attention was then directed towards the first metatarsal, where the periosteal tissue was retracted and a rongeur was used to take a bone biopsy of the first metatarsal head as well specimen for aerobic and anaerobic cultures. At this time, the attention was then directed towards the base of the proximal phalanx, where again the bone rongeurs were used to take a bone biopsy as well as aerobic and anaerobic tissue culture specimen. At this time, with the use of a bone graft, the first metatarsal head and shaft were smoothed as well as the medial and lateral aspect of the proximal phalanx. The wound was then flushed with copious amounts of sterile saline. The capsule and deep tissue were reapproximated with the use of 3-0 Vicryl, the subcutaneous tissue was reapproximated using 4-0 Vicryl, and the skin was closed using interrupted horizontal mattress stitch of 4-0 Prolene. The surgical site was then dressed with Betadine-soaked Adaptic, 4x4 gauze, Kerlix, and Ace wrap. The patient tolerated the procedure and anesthesia well. The patient was transferred to the recovery room with vital signs stable and vascular status intact
Dr. office sent over 28124. Culture shows MRSA. I've asked two different coders and they are as perplexed as I am. This is a Medicare pt. Any help is greatly appreciated!!!