Kaitbohrer
Contributor
I am inclined to code 20680 ONCE for this procedure.
My physician thinks 20680 x2 + 10180 x2 is appropriate. Is there a compromise on this?
Thank you in advance!
PROCEDURE PERFORMED:
1. Irrigation and debridement of medial and lateral ankle wounds including excisional debridement of the skin, subcutaneous tissue, fascia, muscle, and bone.
2. Removal of hardware from medial and lateral ankle through 2 separate incisions.
Op Rpt:
Patient had an ankle fracture and syndesmotic fixation treated at an outside facility months prior.
A few months following initial procedure the patient was noted to have an infection of his hardware and so all of the hardware with the exception of the TightRope was removed in order to allow some residual stabilization of the syndesmosis. The patient did well after that, however, in the past week or so, he had a wound developed on his medial ankle with some swelling in this area.
I discussed irrigation and debridement of this wound and removal of the syndesmotic screw and it has been several months since his initial surgery and that his syndesmosis likely healed.
We started by extending the patient's MEDIAL wound, which measured approximately 7 mm, both proximally and distally. There was some fibrinous exudate in the wound, which was excised. We also excised some of the skin edges that appeared infected. We then dissected down through subcutaneous tissues, taking care to coagulate any crossing vessels. We then took cultures of this wound. We then identified the suture button for the TightRope on the medial side. The sutures were cut from this area and the button was removed.
We then turned our attention to the LATERAL side. We made an incision over the fibula using the patient's prior incision. We dissected down through the subcutaneous tissues, taking care to coagulate any crossing vessels. We then identified the suture button on the fibular side, but still has sutures in place. We removed the suture button along with the sutures that were crossing the syndesmosis. We then took fluoroscopic images, which showed that the hardware had been removed. We then performed dorsiflexion and external rotation stress test and there is no medial clear space widening or syndesmotic widening and syndesmosis appeared to be stable.
We then used 3 liters of normal saline to irrigate and debride both wounds. We debrided the skin, subcutaneous tissue, fascia, muscle, and bone. We used a curette to debride the bone to the tract where the sutures were running for the TightRope. Of note, after during removal of the lateral suture button, there was a small amount of purulence noted. We took cultures of this and then antibiotics were given. After thorough debridement of the area with 3 liters of normal saline, there was no apparent residual infection. We then closed the wound using 3-0 nylon suture. We then applied a sterile dressing ……..
My physician thinks 20680 x2 + 10180 x2 is appropriate. Is there a compromise on this?
Thank you in advance!
PROCEDURE PERFORMED:
1. Irrigation and debridement of medial and lateral ankle wounds including excisional debridement of the skin, subcutaneous tissue, fascia, muscle, and bone.
2. Removal of hardware from medial and lateral ankle through 2 separate incisions.
Op Rpt:
Patient had an ankle fracture and syndesmotic fixation treated at an outside facility months prior.
A few months following initial procedure the patient was noted to have an infection of his hardware and so all of the hardware with the exception of the TightRope was removed in order to allow some residual stabilization of the syndesmosis. The patient did well after that, however, in the past week or so, he had a wound developed on his medial ankle with some swelling in this area.
I discussed irrigation and debridement of this wound and removal of the syndesmotic screw and it has been several months since his initial surgery and that his syndesmosis likely healed.
We started by extending the patient's MEDIAL wound, which measured approximately 7 mm, both proximally and distally. There was some fibrinous exudate in the wound, which was excised. We also excised some of the skin edges that appeared infected. We then dissected down through subcutaneous tissues, taking care to coagulate any crossing vessels. We then took cultures of this wound. We then identified the suture button for the TightRope on the medial side. The sutures were cut from this area and the button was removed.
We then turned our attention to the LATERAL side. We made an incision over the fibula using the patient's prior incision. We dissected down through the subcutaneous tissues, taking care to coagulate any crossing vessels. We then identified the suture button on the fibular side, but still has sutures in place. We removed the suture button along with the sutures that were crossing the syndesmosis. We then took fluoroscopic images, which showed that the hardware had been removed. We then performed dorsiflexion and external rotation stress test and there is no medial clear space widening or syndesmotic widening and syndesmosis appeared to be stable.
We then used 3 liters of normal saline to irrigate and debride both wounds. We debrided the skin, subcutaneous tissue, fascia, muscle, and bone. We used a curette to debride the bone to the tract where the sutures were running for the TightRope. Of note, after during removal of the lateral suture button, there was a small amount of purulence noted. We took cultures of this and then antibiotics were given. After thorough debridement of the area with 3 liters of normal saline, there was no apparent residual infection. We then closed the wound using 3-0 nylon suture. We then applied a sterile dressing ……..