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Essay on Medical Billing and Coding

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1. Ann Borden | SURGEON: | Mohomad Almaz, MD | DIAGNOSIS: | Right carpal tunnel syndrome | PROCEDURE PERFORMED: | Right carpal tunnel release | 2. | | | 3.
PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this …show more content…

LOCATION: Outpatient, Hospital

PATIENT: Judy Rain

SURGEON: Mohamad Almaz, MD

PREOPERATIVE DIAGNOSIS: Chondromalacia, left knee

POSTOPERATIVE DIAGNOSIS: Chondromalacia, left knee, due to sudden overexertion

PROCEDURE PERFORMED: Arthroscopy, left knee, with debridement of chondromalacia

PROCEDURE: While under a spinal anesthetic the patient's knee was examined. She had a small effusion in her knee. Physical exam of her left knee showed her skin intact. Her collateral ligaments were intact. The Lachman's test was negative as was the pivot shift. McMurray's test was negative. She has a range of motion 0 to at least 125 degrees flexion. Her left knee was then prepped with Betadine and draped in a sterile fashion.

An Esmarch bandage was used to exsanguinate the leg and a tourniquet time ended up being 27 minutes. Three portals were used for this procedure. The first was placed along the superior anterolateral aspect and a third along the inferior anteromedial aspect of the knee. We distended the knee with Lactated Ringer's solution. We examined the suprapatellar pouch and the medial and lateral gutters. She had significant chondromalacia starting al the patellofemoral joint. We did use shavers to trim and debride some of the chondromalacia on the trochlea. We then moved to the medial compartment and noted large areas of chondromalacia. We used a combination of basket forceps and the shaver to try to

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