DebbieChicoine
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I hope someone can help me with a podiatry question. I am trying to figure out what cpt to bill for ?
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room,and placed in the supine position. No pneumatic ankle tourniquet was used in this case. Her right foot was prepped and draped in the usual sterile
manner. The nursing assistant administered IV sedation and the surgeon
administered 25 cc of a 1:1 mixture of 1% plain lidocaine and 0.5% plain
Marcaine into the right forefoot. Attention was then directed to the
dorsal aspect of the right foot, which is known to have a very flexed
digit on the right second toe that was rigid. This flexed at the proximal
interphalangeal joint. There was also limited motion at the second
metatarsophalangeal joint. On review of the patient's x-ray, it revealed
that there was a slight dorsal dislocation of the second digit on to the
metatarsal head. A linear incision was made from the head of the
intermediate phalanx of the second toe. Proximally to end of the midshaft
of the second metatarsal, an incision was made with a #15 blade down to
the level of the fascia. Once the level of the proximal interphalangeal
joint was reached, it was transected at this level reflecting the extensor
digitorum longus tendon both distally and proximally as well as resecting
the capsular ligaments at the medial and lateral aspect of the second
proximal interphalangeal joint, nearby exposing the head of the proximal
phalanx. The head of the proximal phalanx was then resected with a power
bone saw. Attention was then directed to the second metatarsophalangeal
joint of this incision. The extensor digitorum longus tendon was
reflected laterally and then the dorsal, medial, and lateral capsular
structures of the second metatarsophalangeal joint were severed,
transected with #15 blade. It was noted that the second digit was in a
dorsal and proximal position on the second metatarsal head. The
metatarsal head was resected with a power bone saw as well as the base of
the proximal phalanx, approximately an 0.8 cm section of the metatarsal
was removed along with 0.3 mm of the base of the proximal phalanx. Once
this was done, a hand-held instrument was used to drill a hole by hand
into the medullary canal of the second metatarsal head and the base of the
proximal phalanx. A broach specifically made for these implants, the
silicone implant kit from Wright Medical was used to insert into the
metatarsal portion of this joint replacement procedure and then into the
base of the proximal phalanx. Once this was deemed appropriate, a
temporary spacer was placed in the position to see how well it fits. It
fits well. This is a size 6. Temporary implant was removed and a sterile
Wright Medical silastic joint implant was used. A short of proximal end
was inserted. On the distal proximal phalanx base, ______ was inserted
into the metatarsal portion. The digit now seems stable. Floating the
forefoot revealed the second digit now sat in a rectus and flattened
position. Range of motion was evaluated and deemed to be normal without
crepitus or catching. The area was irrigated with copious amounts of
sterile saline solution. Deep, soft tissue structures were then closed
using 4-0 Vicryl suture. This included closing the capsule, the second
metatarsophalangeal joint, as well as re-approximating and maintaining the
extensor digitorum longus tendon at the level of the proximal
interphalangeal joint. The skin was closed using 4-0 nylon suture in a
simple interrupted type manner. A dry sterile compressive dressing
consisting of Xeroform gauze, sterile 4 x 4's, Kling, and an Ace wrap was
applied. The patient left the operating room in good condition with vital
signs stable/normal. Capillary refill time of the right foot digit to be
two seconds. The patient will keep her dressing dry, clean, and intact
for one week and will use postoperative shoe, elevate the limb to the
level above the heart for 20 minutes per hour over the next 4-5 days to
decrease swelling. Ambulate no greater than 10-15 minutes per hour.
Appreciate any help with this one! Thanks Deb
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room,and placed in the supine position. No pneumatic ankle tourniquet was used in this case. Her right foot was prepped and draped in the usual sterile
manner. The nursing assistant administered IV sedation and the surgeon
administered 25 cc of a 1:1 mixture of 1% plain lidocaine and 0.5% plain
Marcaine into the right forefoot. Attention was then directed to the
dorsal aspect of the right foot, which is known to have a very flexed
digit on the right second toe that was rigid. This flexed at the proximal
interphalangeal joint. There was also limited motion at the second
metatarsophalangeal joint. On review of the patient's x-ray, it revealed
that there was a slight dorsal dislocation of the second digit on to the
metatarsal head. A linear incision was made from the head of the
intermediate phalanx of the second toe. Proximally to end of the midshaft
of the second metatarsal, an incision was made with a #15 blade down to
the level of the fascia. Once the level of the proximal interphalangeal
joint was reached, it was transected at this level reflecting the extensor
digitorum longus tendon both distally and proximally as well as resecting
the capsular ligaments at the medial and lateral aspect of the second
proximal interphalangeal joint, nearby exposing the head of the proximal
phalanx. The head of the proximal phalanx was then resected with a power
bone saw. Attention was then directed to the second metatarsophalangeal
joint of this incision. The extensor digitorum longus tendon was
reflected laterally and then the dorsal, medial, and lateral capsular
structures of the second metatarsophalangeal joint were severed,
transected with #15 blade. It was noted that the second digit was in a
dorsal and proximal position on the second metatarsal head. The
metatarsal head was resected with a power bone saw as well as the base of
the proximal phalanx, approximately an 0.8 cm section of the metatarsal
was removed along with 0.3 mm of the base of the proximal phalanx. Once
this was done, a hand-held instrument was used to drill a hole by hand
into the medullary canal of the second metatarsal head and the base of the
proximal phalanx. A broach specifically made for these implants, the
silicone implant kit from Wright Medical was used to insert into the
metatarsal portion of this joint replacement procedure and then into the
base of the proximal phalanx. Once this was deemed appropriate, a
temporary spacer was placed in the position to see how well it fits. It
fits well. This is a size 6. Temporary implant was removed and a sterile
Wright Medical silastic joint implant was used. A short of proximal end
was inserted. On the distal proximal phalanx base, ______ was inserted
into the metatarsal portion. The digit now seems stable. Floating the
forefoot revealed the second digit now sat in a rectus and flattened
position. Range of motion was evaluated and deemed to be normal without
crepitus or catching. The area was irrigated with copious amounts of
sterile saline solution. Deep, soft tissue structures were then closed
using 4-0 Vicryl suture. This included closing the capsule, the second
metatarsophalangeal joint, as well as re-approximating and maintaining the
extensor digitorum longus tendon at the level of the proximal
interphalangeal joint. The skin was closed using 4-0 nylon suture in a
simple interrupted type manner. A dry sterile compressive dressing
consisting of Xeroform gauze, sterile 4 x 4's, Kling, and an Ace wrap was
applied. The patient left the operating room in good condition with vital
signs stable/normal. Capillary refill time of the right foot digit to be
two seconds. The patient will keep her dressing dry, clean, and intact
for one week and will use postoperative shoe, elevate the limb to the
level above the heart for 20 minutes per hour over the next 4-5 days to
decrease swelling. Ambulate no greater than 10-15 minutes per hour.
Appreciate any help with this one! Thanks Deb