such78
Expert
Postoperative diagnoses”
I inspected the planta medial scar, where she initially had her open wound. At this points, realizing that to excise this scar might require undermining or potentially a flap, plastic surgery was consulted intraoperatively to further evaluate this area. They then scrubbed into the case and performed a scar excision as well as mobilization of soft tissues for our closure. At this point, having gained access to the planta aspect of the calcaneus , an ostectomy was performed with osteotome as well as power rasp to remove the painful planta calcaneal malunion fragments. There were rasped smooth and the pressure was thus removed from this weighbearing surgace. After performing this, we turned our attention to the lateral portion of the ankle. A sinus tarsi incision was first made. We incised skin and subcutaneous tissue. We then dissected down to the subtalar joint. An arthrotomy was made and dense scar tissue was removed from the subtalar joint. At this point, the subtalar joint, while showing no fusion on CAT scan, appeared to be quite fused. We use a knife, rongeur, and osteotomes to try to mobilize the talar joint, but it was quite fixed and so at this point, we made the decision to not perform subtalar arthrodesis. We did perform further ostectomy of the lateral calcaneus. We then exposed the plate, after first performing tenolysis of the peroneus longus and brevis tendons and mobilizing there. The screws were removed from the plate through this incision. We then had to reopen the lateral extensile incision partially to remove the more posterior screws. We then were able to remove the plate, after first removing dese bony overgrowth. At this ,having removed the painful hardware and painful ostectomy and revised the scar, we did not elect to perform a subtalar arthrodesis. We also did not elect to performed a calcaneal heel slide, give that we had to make both a lateral extensile and sinus tarsi incision to remove the plate and did not want to further traumatize any soft tissues.
Am I correct to assign 20680 and 28120 or 28300 for this case?
- Symptomatic hardware
- Peroneal tenosynovitis
- Painful calcaneal maulnion
- Painful scar tissue
- Hardware removal from right calcaneus
- Ostectomy of plantar portion of calcaneous
- Tenolysis of peroneus brevis tendon
- Tenolysis of peroneus longus tendon
- Subtalar joint arthrotomy and debridement
I inspected the planta medial scar, where she initially had her open wound. At this points, realizing that to excise this scar might require undermining or potentially a flap, plastic surgery was consulted intraoperatively to further evaluate this area. They then scrubbed into the case and performed a scar excision as well as mobilization of soft tissues for our closure. At this point, having gained access to the planta aspect of the calcaneus , an ostectomy was performed with osteotome as well as power rasp to remove the painful planta calcaneal malunion fragments. There were rasped smooth and the pressure was thus removed from this weighbearing surgace. After performing this, we turned our attention to the lateral portion of the ankle. A sinus tarsi incision was first made. We incised skin and subcutaneous tissue. We then dissected down to the subtalar joint. An arthrotomy was made and dense scar tissue was removed from the subtalar joint. At this point, the subtalar joint, while showing no fusion on CAT scan, appeared to be quite fused. We use a knife, rongeur, and osteotomes to try to mobilize the talar joint, but it was quite fixed and so at this point, we made the decision to not perform subtalar arthrodesis. We did perform further ostectomy of the lateral calcaneus. We then exposed the plate, after first performing tenolysis of the peroneus longus and brevis tendons and mobilizing there. The screws were removed from the plate through this incision. We then had to reopen the lateral extensile incision partially to remove the more posterior screws. We then were able to remove the plate, after first removing dese bony overgrowth. At this ,having removed the painful hardware and painful ostectomy and revised the scar, we did not elect to perform a subtalar arthrodesis. We also did not elect to performed a calcaneal heel slide, give that we had to make both a lateral extensile and sinus tarsi incision to remove the plate and did not want to further traumatize any soft tissues.
Am I correct to assign 20680 and 28120 or 28300 for this case?