We need help trying to code a: CAPITELLAR AVASCULAR NECROSIS DRILLING on the Elbow.
Here is the OP Note:
PREOPERATIVE DIAGNOSIS: Right elbow Panner's disease.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURES:
1. Right elbow arthroscopy and debridement.
2. Capitellar AVM drilling.
3. Three views of the elbow, AP and oblique.
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is an 11-year-old, otherwise healthy, history of elbow pain, found to have an area of avascular necrosis. Surgery was discussed in detail including risks included but not limited to risk of anesthesia,
infection, nerve injury, loss of motion, loss of function, need for reoperation, failure to relive symptoms, reflex sympathetic dystrophy, failure to relieve symptoms, avascular necrosis, growth arrest and need for revision surgery. The patient is aware of the risks and wished to proceed and mother gave consent for procedure.
INTRAOPERATIVE FINDINGS: Include some significant laxity in the entire elbow joint with some very shallow trochlear notch.
DESCRIPTION OF PROCEDURE: After signing proper consent form by the patient's mother, the patient was taken to the operating room, given IV antibiotics, underwent LMA general anesthesia. The patient was then positioned in the side lying position, padding all bony prominences. Proximal arm tourniquet placed. The hand prepped and draped in usual sterile fashion, Betadine solution, Esmarch exsanguination, inflation of tourniquet to 250 mmHg. Posterior and posterolateral arthroscopic portals were established. Posterior arthroscopy carried out. Joint was free of debris. There was significant laxity in both the medial and lateral joint _____ drive the scope through the ulnohumeral joint. On the posterior lateral joint, there was significant redundant tissue, scar tissue and inflamed tissue. A posterolateral arthroscopic portal was established and shaver brought into the joint. This was debrided free. Next, in the anteromedial joint, arthroscopic portal was established. The anterior joint was evaluated. The radiocapitellar joint was intact. There was definitely some laxity and I did not see any damage to the articular cartilage. Appropriate pictures were taken. Wound was thoroughly irrigated. Skin was closed using a 4-0 nylon.
Next, under fluoroscopic guidance, retrograde drilling of the capitellum was then performed percutaneously to the subchondral surface of the capitellum in the area of the avascular necrosis. This was done using a 0.062 K-wire x4 holes. Appropriate pictures were taken and felt to be appropriately decompressed. The patient tolerated the procedure well and was taken to recovery in stable condition.
I was able to find the Panner's Disease is Little league elbow due to overuse but i cannot locate anything in the coding book referencing the AVN CAPITELLAR DRILLING.
Thank you,
Melanie
Here is the OP Note:
PREOPERATIVE DIAGNOSIS: Right elbow Panner's disease.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURES:
1. Right elbow arthroscopy and debridement.
2. Capitellar AVM drilling.
3. Three views of the elbow, AP and oblique.
ANESTHESIA: General.
INDICATIONS FOR PROCEDURE: The patient is an 11-year-old, otherwise healthy, history of elbow pain, found to have an area of avascular necrosis. Surgery was discussed in detail including risks included but not limited to risk of anesthesia,
infection, nerve injury, loss of motion, loss of function, need for reoperation, failure to relive symptoms, reflex sympathetic dystrophy, failure to relieve symptoms, avascular necrosis, growth arrest and need for revision surgery. The patient is aware of the risks and wished to proceed and mother gave consent for procedure.
INTRAOPERATIVE FINDINGS: Include some significant laxity in the entire elbow joint with some very shallow trochlear notch.
DESCRIPTION OF PROCEDURE: After signing proper consent form by the patient's mother, the patient was taken to the operating room, given IV antibiotics, underwent LMA general anesthesia. The patient was then positioned in the side lying position, padding all bony prominences. Proximal arm tourniquet placed. The hand prepped and draped in usual sterile fashion, Betadine solution, Esmarch exsanguination, inflation of tourniquet to 250 mmHg. Posterior and posterolateral arthroscopic portals were established. Posterior arthroscopy carried out. Joint was free of debris. There was significant laxity in both the medial and lateral joint _____ drive the scope through the ulnohumeral joint. On the posterior lateral joint, there was significant redundant tissue, scar tissue and inflamed tissue. A posterolateral arthroscopic portal was established and shaver brought into the joint. This was debrided free. Next, in the anteromedial joint, arthroscopic portal was established. The anterior joint was evaluated. The radiocapitellar joint was intact. There was definitely some laxity and I did not see any damage to the articular cartilage. Appropriate pictures were taken. Wound was thoroughly irrigated. Skin was closed using a 4-0 nylon.
Next, under fluoroscopic guidance, retrograde drilling of the capitellum was then performed percutaneously to the subchondral surface of the capitellum in the area of the avascular necrosis. This was done using a 0.062 K-wire x4 holes. Appropriate pictures were taken and felt to be appropriately decompressed. The patient tolerated the procedure well and was taken to recovery in stable condition.
I was able to find the Panner's Disease is Little league elbow due to overuse but i cannot locate anything in the coding book referencing the AVN CAPITELLAR DRILLING.
Thank you,
Melanie
Avn capitellar drilling
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