pcorbisiero1231@comcast.net
Contributor
Need help with the following OP Report. I am thinking the cpt codes should be 28200 and 28122 (tenolysis inclusive).
Thank you.
PREOPERATIVE DIAGNOSES:
1. Left peroneus longus and brevis tenosynovitis.
2. Painful left os peroneum.
3. Left peroneus longus tendon partial tear.
POSTOPERATIVE DIAGNOSES:
1. Left peroneus longus and brevis tenosynovitis.
2. Painful left os peroneum.
3. Left peroneus longus tendon partial tear.
PROCEDURES PERFORMED:
1. Left peroneus longus and brevis tenolysis.
2. Excision of left foot os peroneum.
3. Left peroneus longus tendon repair.
4. Left ankle block for anesthetic injections at the posterior
tibial nerve, the saphenous nerve, the deep peroneal nerve,
the superficial peroneal nerve, and the sural nerve.
5. Interpretation of intraoperative fluoroscopy
INDICATIONS FOR PROCEDURE: This is a 39-year-old woman who
underwent right os peroneum excision for chronic pain greater
than 2 years, 7 months ago. She developed plantar lateral left
foot pain in December, and MRI and x-rays revealed edema at the
os peroneum with a possible fracture line. There was a small
amount of fluid around the distal peroneus longus and brevis
tendons suggestive of tenosynovitis
DESCRIPTION OF PROCEDURE: The patient was administered Ancef 2
grams IV. She was placed in the lateral decubitus position
after receiving the spinal anesthetic. An axillary roll was
placed in the right axilla. All bony prominences were well
padded. She was secured in the lateral position with a vacuum
beanbag. A tourniquet was placed on the left upper thigh but
not inflated. The left foot and ankle were prepped and draped
in the usual sterile fashion with the Betadine scrub and
Betadine paint. An Esmarch bandage was used to exsanguinate the
left foot and wrapped around the ankle three times as a
tourniquet. Fluoroscopic imaging was used to localize the os
peroneum. A longitudinal incision was made at the lateral left
foot over the cuboid directly over the os peroneum. Blunt
dissection was carried down through the subcutaneous tissues and
electrocautery was used for crossing veins. Adhesions between
the peroneus longus tendon and adjacent fascia and soft tissues
were released with tenotomy scissors completing tenolysis of the
peroneus longus tendon. The os peroneum was visualized and
excised sharply from the peroneus longus tendon with a #15 blade
scalpel. The resultant defect was slightly more than 50% of the
peroneus longus tendon diameter. The peroneus longus partial
tear was then repaired with 3-0 Ethibond figure-of-eight
sutures. Three sutures were placed bringing the tendon ends
together without undue tension. Attention was then turned to
the peroneus brevis tendon superior and anterior to the longus
tendon. The tendon was dissected away from the surrounding
subcutaneous tissue and fascia releasing adhesions and
completing peroneus brevis tenolysis. The fluoroscope revealed
no retained loose body or os peroneum at the plantar lateral
foot. The skin was then closed with 3-0 Vicryl subcutaneous
interrupted sutures. The 4-0 Monocryl was run subcutaneously as
well and Steri-Strips were applied. Then, 25 mL of 0.5%
Marcaine was injected circumferentially around the left ankle to
anesthetize the sural nerve, the superficial peroneal nerve, the
deep peroneal nerve, the saphenous nerve, and the posterior
tibial nerve. Then, 5 mL of 0.5% Marcaine was injected into the
incision site. The tourniquet was released at the left ankle
and there was good capillary refill at the toes. A sterile
Adaptic, gauze, Webril dressing, and posterior fiberglass short
leg splint were applied with the foot in 20 degrees of equinus.
Thank you.
PREOPERATIVE DIAGNOSES:
1. Left peroneus longus and brevis tenosynovitis.
2. Painful left os peroneum.
3. Left peroneus longus tendon partial tear.
POSTOPERATIVE DIAGNOSES:
1. Left peroneus longus and brevis tenosynovitis.
2. Painful left os peroneum.
3. Left peroneus longus tendon partial tear.
PROCEDURES PERFORMED:
1. Left peroneus longus and brevis tenolysis.
2. Excision of left foot os peroneum.
3. Left peroneus longus tendon repair.
4. Left ankle block for anesthetic injections at the posterior
tibial nerve, the saphenous nerve, the deep peroneal nerve,
the superficial peroneal nerve, and the sural nerve.
5. Interpretation of intraoperative fluoroscopy
INDICATIONS FOR PROCEDURE: This is a 39-year-old woman who
underwent right os peroneum excision for chronic pain greater
than 2 years, 7 months ago. She developed plantar lateral left
foot pain in December, and MRI and x-rays revealed edema at the
os peroneum with a possible fracture line. There was a small
amount of fluid around the distal peroneus longus and brevis
tendons suggestive of tenosynovitis
DESCRIPTION OF PROCEDURE: The patient was administered Ancef 2
grams IV. She was placed in the lateral decubitus position
after receiving the spinal anesthetic. An axillary roll was
placed in the right axilla. All bony prominences were well
padded. She was secured in the lateral position with a vacuum
beanbag. A tourniquet was placed on the left upper thigh but
not inflated. The left foot and ankle were prepped and draped
in the usual sterile fashion with the Betadine scrub and
Betadine paint. An Esmarch bandage was used to exsanguinate the
left foot and wrapped around the ankle three times as a
tourniquet. Fluoroscopic imaging was used to localize the os
peroneum. A longitudinal incision was made at the lateral left
foot over the cuboid directly over the os peroneum. Blunt
dissection was carried down through the subcutaneous tissues and
electrocautery was used for crossing veins. Adhesions between
the peroneus longus tendon and adjacent fascia and soft tissues
were released with tenotomy scissors completing tenolysis of the
peroneus longus tendon. The os peroneum was visualized and
excised sharply from the peroneus longus tendon with a #15 blade
scalpel. The resultant defect was slightly more than 50% of the
peroneus longus tendon diameter. The peroneus longus partial
tear was then repaired with 3-0 Ethibond figure-of-eight
sutures. Three sutures were placed bringing the tendon ends
together without undue tension. Attention was then turned to
the peroneus brevis tendon superior and anterior to the longus
tendon. The tendon was dissected away from the surrounding
subcutaneous tissue and fascia releasing adhesions and
completing peroneus brevis tenolysis. The fluoroscope revealed
no retained loose body or os peroneum at the plantar lateral
foot. The skin was then closed with 3-0 Vicryl subcutaneous
interrupted sutures. The 4-0 Monocryl was run subcutaneously as
well and Steri-Strips were applied. Then, 25 mL of 0.5%
Marcaine was injected circumferentially around the left ankle to
anesthetize the sural nerve, the superficial peroneal nerve, the
deep peroneal nerve, the saphenous nerve, and the posterior
tibial nerve. Then, 5 mL of 0.5% Marcaine was injected into the
incision site. The tourniquet was released at the left ankle
and there was good capillary refill at the toes. A sterile
Adaptic, gauze, Webril dressing, and posterior fiberglass short
leg splint were applied with the foot in 20 degrees of equinus.