New to Podiatry Surgery ...*Help Please**

twalls

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Preoperative Diagnoses:
1. Hypertrophic bone/malunion, left navicular.
2. Chronic synovitis with arthralgia, left ankle.

Postoperative Diagnoses:
1. Hypertrophic bone/malunion, left navicular.
2. Chronic synovitis with arthralgia, left ankle.

Procedure:
1. Open repair of malunion/nonunion, left navicular.
2. Arthrotomy with synovectomy, left ankle.

Anesthesia:
General with popliteal block, administered by for
postoperative analgesia.

Estimated Blood Loss:
Less than 20 cc.

Complications:
None.

Specimens:
Bone and soft tissue.

Description Of Procedure:
The patient was brought to the operating room. The popliteal
block had already been administered by, in the holding
area. He then placed her under general anesthetic. I
administered a saphenous nerve block with 3 cc of 2% lidocaine
and 0.5% Marcaine. The left foot and ankle were prepped in the
usual manner with Betadine. The limb was elevated. Calf
tourniquet was inflated to 250 mm Hg.

Repair of nonunion, left navicular, with saucerization of
hypertrophic bone, talonavicular joint: A 4 cm incision was
made roughly 2 cm medial to the dorsalis pedis artery. A
layered dissection was carried out. The tibialis anterior
tendon was protected medially down to the capsular tissue. A
linear cut was made. Tissue was freed off the talonavicular
joint. The heavy fibrous malunion/nonunion piece of bone was
resected from the dorsal aspect of the navicular. The remaining
hypertrophic bone of the talonavicular joint was resected off
with an osteotome, mallet, and power bur and hand-filed back to
a smooth contour. The cartilage in that area appeared healthy.
It was later repaired with Vicryl and nylon. The anterior
aspect of the ankle was inspected in that area as well. The
cartilage in the front of the talus was intact and was slightly
sandy in appearance. The medial aspect of the ankle joint was
identified. There was fibrous tissue in that area in the
vertical component. That was resected. The area was irrigated
and repaired with Vicryl and nylon.
Arthrotomy with synovectomy, left ankle: A 5 cm curved incision
was made laterally over the ankle joint. Layered dissection was
carried down to the joint level. The ankle was exposed. There
was some reactive synovitis, which was resected. The anterior
and lateral joint margins of the talus were fibrous, vascular,
and angry. Capsular tissue was freed. A power bur was used to
run along the front edge to get rid of that hypertrophic,
hypervascular area of bone back to healthy bleeding bone. No
major loose bodies or defects were found. The area was
irrigated. The ligament was repaired with 3-0 Vicryl, the
fascia with 4-0 Vicryl, the skin with 4-0 nylon.

It was dressed with Xeroform, fluff gauze, and Kerlix.
Tourniquet time was approximately 1 hour. Vascular was intact
to the foot. A short-leg fiberglass walking cast was applied.
The patient left the operating room in good condition


SO...I am thinking 28320 and 27625 or am I way off?? THANK YOU SO MUCH!

Tammy, CPC
 

Orthocoderpgu

True Blue
Local Chapter Officer
Messages
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Location
Salt Lake City, UT
Best answers
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I like both codes, but you need a modifier

Normally synovectomy is performed routinely and is not billed separately if another procedure is performed. However in this case I think both codes are supported since they were performed through separate incisions and different parts of the ankle/foot. Use a -59 on the procedure with the lowest RVU.
 

twalls

Contributor
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Normally synovectomy is performed routinely and is not billed separately if another procedure is performed. However in this case I think both codes are supported since they were performed through separate incisions and different parts of the ankle/foot. Use a -59 on the procedure with the lowest RVU.
Thanks so much!
 
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