AR2728
Expert
I've reviewed the related posts already out there, but I want to make sure I am correct on this before billing. No incision was made so this can't be billed as open treatment. I'm looking at 27818 closed treat trimalleolar w/manipulation, 20692 external fixator placement, and 11010-11011 debridement fracture. Agree? However, I did find that the 20692 is mutually exclusive to the debridement codes.
diagnosis: Open discloated trimalleolar fracture
Procedure:
Prior to prepping and draping the left ankle, a scrub brush was used to scrub the bone with chlorhexidine. After this the leg was prepped and draped in a sterile manner. Once the leg was prepped and draped in a sterile manner. A separate sterile brush withBetadine was used to scrub the open wound. The patient had a large laceration medially to posteriorly. The wound was then copiously irrigated under pulsatile lavage with 1200 cc of crystalloid with Bacitracin. In between each washing the wound was debrided and removed foreign debris including grass and dirt. Once the wound was completely irrigated and debrided. The patient's ankle was reduced under fluoroscopy. At this point in time an external fixator placement and a delta type frame was placed. This was by placing a transverse pin across the calcaneus and two anterior to posterior pins in the tibia. These were viewed under fluoroscopy and showed appropriate positioning. A multiplane delta frame was then configured and the ankle was held in reduction. Final x-rays were taken and showed appropriate reduction and external fixator placement. The wound was then closed with prolene suture loosely to allow drainage. Twenty cc of ?% Marcaine was injected into the incision site and the pin sites. A sterile soft dressing of Xeroform, 4X4, Kerlix and ace bandage placed around the external fixator.
diagnosis: Open discloated trimalleolar fracture
Procedure:
Prior to prepping and draping the left ankle, a scrub brush was used to scrub the bone with chlorhexidine. After this the leg was prepped and draped in a sterile manner. Once the leg was prepped and draped in a sterile manner. A separate sterile brush withBetadine was used to scrub the open wound. The patient had a large laceration medially to posteriorly. The wound was then copiously irrigated under pulsatile lavage with 1200 cc of crystalloid with Bacitracin. In between each washing the wound was debrided and removed foreign debris including grass and dirt. Once the wound was completely irrigated and debrided. The patient's ankle was reduced under fluoroscopy. At this point in time an external fixator placement and a delta type frame was placed. This was by placing a transverse pin across the calcaneus and two anterior to posterior pins in the tibia. These were viewed under fluoroscopy and showed appropriate positioning. A multiplane delta frame was then configured and the ankle was held in reduction. Final x-rays were taken and showed appropriate reduction and external fixator placement. The wound was then closed with prolene suture loosely to allow drainage. Twenty cc of ?% Marcaine was injected into the incision site and the pin sites. A sterile soft dressing of Xeroform, 4X4, Kerlix and ace bandage placed around the external fixator.