clegrand
Contributor
I am having some trouble effectively coding all of this. I would appreciate any input or advice! I have had limited training/experience with ortho, so I welcome the help. Thanks!!
I have attached the op notes.
This is what I have come up with so far....
881.10, laceration of forearm
955.9, laceration of interosseous nerve
???, small chip fracture of the ulna
64857, reapproximation of interosseous nerve
???, repair of bony mass
POSTOPERATIVE DIAGNOSIS: Machete laceration of right proximal forearm
with laceration of the superficial extensor belly mass, laceration of
posterior interosseous nerve, and small chip fracture off the ulna.
OPERATION: Irrigation and debridement of wound, reapproximation of
posterior interosseous nerve, repair of extensor bony mass, insertion of
a Penrose drain and wound closure.
ANESTHESIA: General LMA.
PROCEDURE: After induction of adequate general LMA anesthesia, the
patient's right arm was prepped and draped in usual sterile fashion with
the right arm being draped free. Some bleeding vessels were clamped and
cauterized from the subcutaneous tissues. An Esmarch bandage was then
applied to exsanguinate the limb and tourniquet elevated to 250 mmHg
pressure.
Wound was irrigated copiously with saline solution using the power
irrigating tool. During the course of the procedure 5 liters of saline
solution were used to irrigate. Soft tissue and the subcutaneous
tissues about the periphery of the lacerations were sharply debrided.
There were 2 distal ulnarly-based flaps with a transverse proximal
component. The laceration went through the superficial muscle belly of
the extensor muscle mass. It appeared that the posterior interosseous
nerve right as it was branching was likewise lacerated with some
incomplete laceration of the deeper muscle tissue. The laceration went
deep down to bone of the ulna. A groove could be palpated and seen on
the ulna with some stripping of the periosteum, but the integrity of the
ulna was intact. Again, some of the tissues were debrided. 2 sutures
of #6 nylon were used to reapproximate the ends of the posterior
interosseous nerve back together. It was somewhat difficult to achieve
because the laceration appeared to occur right where the nerve was
branching. The fascia and some of the muscle in the laceration was then
repaired with sutures of 0 Vicryl. Additional subcutaneous tissue
debridement and irrigation was performed. A 1/4-inch Penrose drain was
placed deep in the wound near the chip fracture of the ulna through a
separate stab wound incision.
Once that was accomplished, subcutaneous tissues were closed with
sutures of 3-0 Vicryl. Skin edges were approximated with stainless
steel surgical clips. Wound was dressed with Xeroform gauze, dry
sterile dressing, cast padding. Volar plaster splint was applied held
in place with a Kling and an Ace wrap. Prior to wound closure the
tourniquet was released and there was not an undue amount of bleeding
present. The patient tolerated procedure well without complication and
was transferred to recovery room in stable condition.
I have attached the op notes.
This is what I have come up with so far....
881.10, laceration of forearm
955.9, laceration of interosseous nerve
???, small chip fracture of the ulna
64857, reapproximation of interosseous nerve
???, repair of bony mass
POSTOPERATIVE DIAGNOSIS: Machete laceration of right proximal forearm
with laceration of the superficial extensor belly mass, laceration of
posterior interosseous nerve, and small chip fracture off the ulna.
OPERATION: Irrigation and debridement of wound, reapproximation of
posterior interosseous nerve, repair of extensor bony mass, insertion of
a Penrose drain and wound closure.
ANESTHESIA: General LMA.
PROCEDURE: After induction of adequate general LMA anesthesia, the
patient's right arm was prepped and draped in usual sterile fashion with
the right arm being draped free. Some bleeding vessels were clamped and
cauterized from the subcutaneous tissues. An Esmarch bandage was then
applied to exsanguinate the limb and tourniquet elevated to 250 mmHg
pressure.
Wound was irrigated copiously with saline solution using the power
irrigating tool. During the course of the procedure 5 liters of saline
solution were used to irrigate. Soft tissue and the subcutaneous
tissues about the periphery of the lacerations were sharply debrided.
There were 2 distal ulnarly-based flaps with a transverse proximal
component. The laceration went through the superficial muscle belly of
the extensor muscle mass. It appeared that the posterior interosseous
nerve right as it was branching was likewise lacerated with some
incomplete laceration of the deeper muscle tissue. The laceration went
deep down to bone of the ulna. A groove could be palpated and seen on
the ulna with some stripping of the periosteum, but the integrity of the
ulna was intact. Again, some of the tissues were debrided. 2 sutures
of #6 nylon were used to reapproximate the ends of the posterior
interosseous nerve back together. It was somewhat difficult to achieve
because the laceration appeared to occur right where the nerve was
branching. The fascia and some of the muscle in the laceration was then
repaired with sutures of 0 Vicryl. Additional subcutaneous tissue
debridement and irrigation was performed. A 1/4-inch Penrose drain was
placed deep in the wound near the chip fracture of the ulna through a
separate stab wound incision.
Once that was accomplished, subcutaneous tissues were closed with
sutures of 3-0 Vicryl. Skin edges were approximated with stainless
steel surgical clips. Wound was dressed with Xeroform gauze, dry
sterile dressing, cast padding. Volar plaster splint was applied held
in place with a Kling and an Ace wrap. Prior to wound closure the
tourniquet was released and there was not an undue amount of bleeding
present. The patient tolerated procedure well without complication and
was transferred to recovery room in stable condition.
