jerseygirl20
Networker
Revision bunionectomy- hardware complication
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Here is the op note below-
Any help on how to code this would be great. Totally lost on this one. I am just not seeing a revision bunionectomy.
Attention was the directed to the dorsal aspect of the first ray where the previous incision was noted. Using a 15 blade, the incision was made. Dissection was carried down through subcutaneous tissues with care being taken to identify and retract all neural and vital vascular structures. The capsule was incised and two large fragments of the first metarsal were dissected free of soft tissue attachements and isolated. Two screws were removed, securing the dorsal fragment but clearly not purchasing the plantar aspect of the more proximal fragment. At this time, there was noted contracture not immediately allowing reduction of the capital fragment. In addition, there was extensive bone loss of the plantar shelf, appox 60% of the plantar shelf was in multiple pieces, primarily Gore Tex coritcal bone. There was some residual shelf at the most poximal margin. At this time with further soft tissue dissection and release as well as lengthening of the extensor hallucis longus of the first metarsal capital fragment reduced acceptably into position, allowing good apposition of the proximal margin of the Scarf osteotomy. Fixation was maintained with a towel clamp. At this time a three hole plate was used to secure the osteotomy site, with very little residual. A lag screw was attempted with no success and isolated plate was utilized. At this time, the length of the hallus of the second toe were critiqued. The procedure was completed.
Thank you
--------------------------------------------------------------------------------
Here is the op note below-
Any help on how to code this would be great. Totally lost on this one. I am just not seeing a revision bunionectomy.
Attention was the directed to the dorsal aspect of the first ray where the previous incision was noted. Using a 15 blade, the incision was made. Dissection was carried down through subcutaneous tissues with care being taken to identify and retract all neural and vital vascular structures. The capsule was incised and two large fragments of the first metarsal were dissected free of soft tissue attachements and isolated. Two screws were removed, securing the dorsal fragment but clearly not purchasing the plantar aspect of the more proximal fragment. At this time, there was noted contracture not immediately allowing reduction of the capital fragment. In addition, there was extensive bone loss of the plantar shelf, appox 60% of the plantar shelf was in multiple pieces, primarily Gore Tex coritcal bone. There was some residual shelf at the most poximal margin. At this time with further soft tissue dissection and release as well as lengthening of the extensor hallucis longus of the first metarsal capital fragment reduced acceptably into position, allowing good apposition of the proximal margin of the Scarf osteotomy. Fixation was maintained with a towel clamp. At this time a three hole plate was used to secure the osteotomy site, with very little residual. A lag screw was attempted with no success and isolated plate was utilized. At this time, the length of the hallus of the second toe were critiqued. The procedure was completed.
Thank you