PREOPERATIVE DIAGNOSIS:
Right below-knee amputation stump ulcer.
POSTOPERATIVE DIAGNOSIS:
Right below-knee amputation stump ulcer.
PROCEDURE PERFORMED:
Right below-knee amputation stump wound revision.
ANESTHESIA:
General with Dr. English.
ESTIMATED BLOOD LOSS:
5 cc.
FINDINGS:
Benign-appearing ulcer at the BKA stump. It was excised, debrided, and closed
primarily.
DETAILS OF THE PROCEDURE:
The patient is a 68-year-old female with prior below-knee amputation, developed
a necrotic wound and ulcer. She was consented for surgery, brought to OR in
supine position, sedated, and intubated without complication. Time-out per
protocol. Preoperative antibiotics given. The right BKA stump was prepped and
draped in the usual sterile fashion. A sharp dissection was used to excise the
tissue around that area and debrided down to healthy bleeding normal tissue.
Then, I proceeded to excise the ulcer itself and down to subcu and muscle and
fat were well-perfused tissue. Then, the wound was widened to create an
ellipse and close primarily with 2-0 nylon in an interrupted fashion. The
patient tolerated the procedure well, and she was extubated and returned to
PACU with vital signs stable.
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Amputation left hallux stump
Patient had a partial amputation in same area years ago but has recurrent ulcerations.
Procedure: Two semi-elliptical incisions were created around the base just distal to the base of the hallux first MPJ and full thickness incisions were created down to bone with 15 blade. Toe was disarticulated and the extensor and flexor tendons were identified, protracted and cut… all devitalized tissues were debrided from the wound…bleeders clamped…
CPT 28810? Also diagnosis T87.44 along with the E11.621 ?
TIA
KAM
Cervicoscopy with D&C of cervical stump with Slimline hysteroscope – need CPT help
I’m thinking I’ll have to bill 58579 Unlisted hysteroscopy procedure, uterus – but I’m unsure of the "compare-to" code. 57558, 57456…? Any suggestions are welcome. Thanks for your help.
Need help coding: Stump revision or just I&D?
Patient’s right lower extremity was marked in the preop period. Patient was then brought back to the OR where she was given spinal followed by general anesthesia. A tourniquet was placed on the patient’s right thigh. Patient’s right lower extremity was prepped and draped in normal sterile fashion. A timeout was taken and was agreed upon by Lillie had the correct site and procedure and correct patient. Next a scalpel blade was used to make a transverse incision following the previous scar at the stump of the AKA. At this point the sinus tract of the abscess at the skin level was ellipsed out. Next the soft tissue abscess approximately 2 cm in diameter was excised from the subcutaneous layer at the apex of the stump. Next a longitudinal incision approximately 3 fingerbreadths in length were his made over the lateral aspect of the thigh over top of a firm area which represented a 2nd soft tissue abscess. The 2nd abscess approximately 3 cm in diameter was excised using electrocautery from the subcutaneous layer. Next using that lateral incision blunt finger dissection was used to free the cavity superficial to the fascia over the lateral aspect of the thigh. Deep cultures were taken at the distal incision. Next at the distal aspect of the stump the fascia was incised down to bone at the distal femur. No gross purulence or soft bone was noted. The content of the intramedullary canal was evacuated at the distal 1 cm. Next large Roger was used to remove approximately 2-3 cm off the distal aspect of the femur circumferentially. Next the distal and lateral wounds were irrigated out with pulse lavage approximately 3 L of saline. Next the subcutaneous layer was reapproximated using PDS in simple stitch fashion. Skin was reapproximated using 2-0 nylon in simple stitch fashion. Prior to wound closure 2 Hemovac drains were placed. The 1st Hemovac was placed adjacent to the distal femur exiting adjacent to the distal incision. The 2nd Hemovac drain was placed along the lateral aspect of the thigh superficial to the fascia. Next the tourniquet was deflated and patient recovered from anesthesia. Then transferred to PACU postoperatively in stable condition.