cwilson3333
Expert
Patient had Total Hip Replacement 27130-RT
Hip dislocated, few days later and Surgeon Attempted Reduction Multiple Times, but unable to reduce [Coded this procedure 27266-79-RT]
Two days later, proceeded with Reduction and Revision of Total Hip [Irreducible closed dislocation of total Hip Arthroplasty] 27134-58-RT
Patient brought into operative theater. placed lateral, given spinal anesthetic. She had been getting regular antibiotics every 4 hours. She was given TXA, positioned on pegboard with right hip up, prepped and draped. She was 3 inches short on that side. Incision made through old incision. Dissection carried down. External rotators had been taken off greater trochanter. The initial closure looked to be very good. The adductors, a portion of those had torn as well. Taking it down to the hip, at this point it was noted that the head of the femur, the MDM polyethylene was locked at the pelvis and actually it took a little bit of pulling it laterally and then superiorly in order to bring it down. It had been out long enough that it took a bit to get her back down to length. I actually reduced her hip at this point and left it like that for a few minutes to stretch out the soft tissues. Her range of motion, she had at this point flexion beyond 90, internal and external rotation of 40 degrees and was reasonably stable. I was afraid because of soft tissue damage and the fact it had been stable before, but dislocated, to leave this the way it was. So process was to do a constrained liner. On attempting to take head off of femur, femur shifted a little bit, so took that out, took femur out, took head out, took liner put of acetabulum. One of screws previously had been sitting a bit out of pelvis, so took this out and repositioned it so it was in pelvis. The acetabulum was very stable and secure. At this time did restoration modular stem, the distal part was a 15, hand reamed in a power ream of 15. The 15 went down just below the tip of the greater trochanter. With the 19 trial anteverted about 15 degrees, the poly, we had the constrained liner trial in the acetabulum, reduced it and she was very stable. The had flexion beyond 90-degrees and she had 45 degrees internal and external rotation with no instability. The trial head was removed. The trial acetabulum shell was removed. At this point the true shell was placed in, it was locked in, and in a good position . At this time, the true 19 body was placed in at 15 degrees of anteversion. I was locked in. The true head, which was a 22.2 metal head, was placed on. It was reduced and found to be very stable. Leg lengths clinically appeared to be good. Irrigated copiously, sciatic nerve protected with blunt retractors throughout the procedure. I was identified by palpation and found to be without pathology....................................no complications and patient seemed to be stable throughout the procedure.
Am I correct on my coding. Not sure if I charge for the Reduction along with the Revision??
Hip dislocated, few days later and Surgeon Attempted Reduction Multiple Times, but unable to reduce [Coded this procedure 27266-79-RT]
Two days later, proceeded with Reduction and Revision of Total Hip [Irreducible closed dislocation of total Hip Arthroplasty] 27134-58-RT
Patient brought into operative theater. placed lateral, given spinal anesthetic. She had been getting regular antibiotics every 4 hours. She was given TXA, positioned on pegboard with right hip up, prepped and draped. She was 3 inches short on that side. Incision made through old incision. Dissection carried down. External rotators had been taken off greater trochanter. The initial closure looked to be very good. The adductors, a portion of those had torn as well. Taking it down to the hip, at this point it was noted that the head of the femur, the MDM polyethylene was locked at the pelvis and actually it took a little bit of pulling it laterally and then superiorly in order to bring it down. It had been out long enough that it took a bit to get her back down to length. I actually reduced her hip at this point and left it like that for a few minutes to stretch out the soft tissues. Her range of motion, she had at this point flexion beyond 90, internal and external rotation of 40 degrees and was reasonably stable. I was afraid because of soft tissue damage and the fact it had been stable before, but dislocated, to leave this the way it was. So process was to do a constrained liner. On attempting to take head off of femur, femur shifted a little bit, so took that out, took femur out, took head out, took liner put of acetabulum. One of screws previously had been sitting a bit out of pelvis, so took this out and repositioned it so it was in pelvis. The acetabulum was very stable and secure. At this time did restoration modular stem, the distal part was a 15, hand reamed in a power ream of 15. The 15 went down just below the tip of the greater trochanter. With the 19 trial anteverted about 15 degrees, the poly, we had the constrained liner trial in the acetabulum, reduced it and she was very stable. The had flexion beyond 90-degrees and she had 45 degrees internal and external rotation with no instability. The trial head was removed. The trial acetabulum shell was removed. At this point the true shell was placed in, it was locked in, and in a good position . At this time, the true 19 body was placed in at 15 degrees of anteversion. I was locked in. The true head, which was a 22.2 metal head, was placed on. It was reduced and found to be very stable. Leg lengths clinically appeared to be good. Irrigated copiously, sciatic nerve protected with blunt retractors throughout the procedure. I was identified by palpation and found to be without pathology....................................no complications and patient seemed to be stable throughout the procedure.
Am I correct on my coding. Not sure if I charge for the Reduction along with the Revision??