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Implant arthroplasty of the right second and third

  1. Default Implant arthroplasty of the right second and third
    Medical Coding Books
    Can someone help me with this. I can' find a code for Implant arthroplasty of the right second and third metatarsophalangeal joints. I have attached the op note.


    PREOPERATIVE DIAGNOSIS: Painful right second and third toes with
    painful hardware of the right foot.

    POSTOPERATIVE DIAGNOSIS: Painful right second and third toes
    with painful hardware of the right foot.

    OPERATIONS DONE:
    1. Implant arthroplasty of the right second and third
    metatarsophalangeal joints.
    2. Hardware removal right foot.

    SURGERY START TIME: As dictated in nurse's report.

    SURGERY END TIME: As dictated in nurse's report.

    TOURNIQUET INFLATED: As dictated in nurse's report.

    TOURNIQUET DEFLATED: As dictated in nurse's report.

    PATHOLOGY SENT: Hardware from the right foot.

    MICROBIOLOGY SENT: None.

    HARDWARE USED: Two Swanson lesser toe implants.

    MATERIALS USED: 3-0 Vicryl suture, 4-0 Vicryl suture, 3-0 nylon
    suture.

    ANESTHESIA: Local with monitored anesthesia care.

    INDICATIONS FOR SURGERY:
    The patient is a 64-year-old white male that presented to the
    clinic complaining of painful right foot. He states that his
    right second and third toes are bothering him when he walks
    causing him significant pain on range of motion.

    Physical examination showed normal neurovascular status with pain
    on palpation and range of motion to the second and third
    metatarsophalangeal joints. Pain on palpation was also noted to
    the right great toe and foot where previous hardware was
    implanted.

    At this time all surgical and conservative options were discussed
    with the patient and he opted for surgical intervention. No
    guarantees were given. Consent was signed under no coercion
    after all risks and benefits were discussed in detail with the
    patient.

    DESCRIPTION OF PROCEDURE:
    The patient was escorted to the Operating Room and placed on the
    operating table in the supine position. The patient was then
    given the above mentioned anesthesia. Pneumatic tourniquet was
    placed at the level of the right ankle. The right foot was then
    prepped and draped using aseptic sterile technique. The right
    foot was then elevated and exsanguinated using Esmarch bandage
    and the pneumatic tourniquet was increased to 250 mmHg and
    remained for the time mentioned above.

    Attention was then directed to the dorsal aspect of the right
    first metatarsophalangeal joint where a previous surgical scar
    was noted. The incision was made over the scar using sharp and
    blunt dissection and paying careful attention to all
    neurovascular structure. The incision was then deepened to the
    level of the hardware which was identified and resected in toto
    using power instrumentation. The hardware was then sent to
    Pathology for analysis. The wound was irrigated and closed using
    3-0 Vicryl suture for deep closure and 4-0 Vicryl suture for
    subcutaneous closure and 3-0 nylon suture for skin closure.

    Attention was then directed to the second and third
    metatarsophalangeal joints where a 4 centimeter linear incision
    between the two joints was performed. The incision was deepened
    through the subcutaneous tissues paying careful attention to all
    neurovascular structures. All bleeders were cauterized at this
    time. The incision was deepened to the level of the
    metatarsophalangeal joints which were identified and incised
    linearly paying careful attention to the extensor digitorum
    longus tendons. The joints were then exposed and resected in
    toto using power instrumentation. The Swanson lesser toe
    implants were then placed inside the second and third
    metatarsophalangeal joints. Free range of motion was noted. The
    wounds were irrigated with copious amounts of normal sterile
    saline. Deep closure was performed using 3-0 Vicryl suture.
    Subcutaneous closure was performed using 4-0 Vicryl suture and
    skin closure was performed with 3-0 nylon suture.

    The pneumatic tourniquet was released at this time and immediate
    hyperemia to all toes was noted. The patient seemed to tolerate
    the anesthesia and the procedure well as was escorted back to the
    Recovery Room with vital signs stable and neurovascular status
    intact.

  2. #2
    Default
    Did you look at code 28293?

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