kimmcelderry@gmail.com
Networker
My MD performed a proximal fibula and tibial osteotomy with tibia intramedullary nail fixation. He submitted:
27709 Osteotomy Tib & Fib and 27759 ORIF Tib fracture w/ IM nail. There is no fracture, so I know this isn't correct and I need help selecting the correct code.
"We directed our attention to the fibular osteotomy and a 3cm incision was created on the lateral border proximally at the level of the anticipated tibial osteotomy which was 10cm from the knee joint. We dissected down to the level of the bone and using a 3.5mm drill bit drilled multiple holes in the fibula and osteotomized it with a corticotomy. We closed the site with Vicryl and nylon.
We placed a ex-fix on the lateral aspect of the tibia to guide our reduction after tibial osteotomy. 2 Schanz pins were placed proximally in the tibia 2cm distal to the joint line and distally above the syndesmotic screw and the external fixator was locked in place.
We directed our attention to the suprapatellar nail entry point. A 3 cm incision was created at the superior pole of the patella proximally and the subcutaneous tissue was incised in line with the skin incision. The quadriceps tendon was split and the patella was mobilized. The trocar obturator system from the Synthes suprapatellar nail was inserted and the entry point was checked by intraoperative fluoroscopy to be at the midpoint tween both tibial eminences. We drove the guidewire and then used the opening reamer to ream over the guidewire and put the ball-tipped guidewire and its exchange.
We drilled the holes for the tibial osteotomy. A stab incision was created at the anterior crest of the tibia 10cm distal to the knee joint at the same level of the fibula osteotomy and the drill was used to create multiple fenestrations in the tibia to vent the canal.
We placed a blocking screw on the lateral aspect of the guidewire and hugging it to prevent valgus deformity from recurring while inserting the nail.
We then started reaming with an 8.5mm reamer and reamed all the way up to 10mm and had good chatter.
We withdrew the guidewire to the level of the osteotomy and finished the osteotomy with an osteotome. The tibial osteotomy was completed, the ex-fix loosened, and the tibia was placed into varus maintaining neutral rotation. The ex-fix was locked in place and the ball-tipped guidewire was driven across the osteotomy site followed by the nail which skived against the blocking screw maintaining the reduction. The nail was locked proximally with screws and distally with the 2 screws after obtaining perfect circles distally."
Thanks for any help or advice.
27709 Osteotomy Tib & Fib and 27759 ORIF Tib fracture w/ IM nail. There is no fracture, so I know this isn't correct and I need help selecting the correct code.
"We directed our attention to the fibular osteotomy and a 3cm incision was created on the lateral border proximally at the level of the anticipated tibial osteotomy which was 10cm from the knee joint. We dissected down to the level of the bone and using a 3.5mm drill bit drilled multiple holes in the fibula and osteotomized it with a corticotomy. We closed the site with Vicryl and nylon.
We placed a ex-fix on the lateral aspect of the tibia to guide our reduction after tibial osteotomy. 2 Schanz pins were placed proximally in the tibia 2cm distal to the joint line and distally above the syndesmotic screw and the external fixator was locked in place.
We directed our attention to the suprapatellar nail entry point. A 3 cm incision was created at the superior pole of the patella proximally and the subcutaneous tissue was incised in line with the skin incision. The quadriceps tendon was split and the patella was mobilized. The trocar obturator system from the Synthes suprapatellar nail was inserted and the entry point was checked by intraoperative fluoroscopy to be at the midpoint tween both tibial eminences. We drove the guidewire and then used the opening reamer to ream over the guidewire and put the ball-tipped guidewire and its exchange.
We drilled the holes for the tibial osteotomy. A stab incision was created at the anterior crest of the tibia 10cm distal to the knee joint at the same level of the fibula osteotomy and the drill was used to create multiple fenestrations in the tibia to vent the canal.
We placed a blocking screw on the lateral aspect of the guidewire and hugging it to prevent valgus deformity from recurring while inserting the nail.
We then started reaming with an 8.5mm reamer and reamed all the way up to 10mm and had good chatter.
We withdrew the guidewire to the level of the osteotomy and finished the osteotomy with an osteotome. The tibial osteotomy was completed, the ex-fix loosened, and the tibia was placed into varus maintaining neutral rotation. The ex-fix was locked in place and the ball-tipped guidewire was driven across the osteotomy site followed by the nail which skived against the blocking screw maintaining the reduction. The nail was locked proximally with screws and distally with the 2 screws after obtaining perfect circles distally."
Thanks for any help or advice.