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Decompression fasciotomy is a surgical procedure aimed at alleviating the pressure within muscle compartments, particularly in the thigh and knee regions, which can become critically elevated due to conditions such as compartment syndrome. Compartment syndrome occurs when swelling within a muscle compartment leads to increased pressure that compresses blood vessels and nerves, potentially resulting in irreversible damage to muscle and nerve tissues. The muscle compartments are encased in fascia, a dense connective tissue that does not stretch, thus any swelling can lead to significant complications. In the thigh and knee area, there are three primary compartments: the flexor, extensor, and adductor (medial) compartments. The procedure involves making an incision over the lateral aspect of the thigh, allowing access to these compartments for evaluation and intervention. The surgical approach includes the inspection and debridement of any nonviable muscle or nerve tissue, which is critical for preserving function and preventing further complications. The procedure is indicated when multiple compartments require decompression, and it is essential to monitor compartment pressures throughout the process to ensure adequate relief of pressure. Following the procedure, the incisions are typically left open and covered with a dressing, with plans for closure once the swelling has decreased, usually within a timeframe of 24 to 72 hours.
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Decompression fasciotomy is indicated for the treatment of compartment syndrome, which can arise from various conditions leading to increased pressure within muscle compartments. The following are specific indications for this procedure:
The procedure for decompression fasciotomy involves several critical steps to ensure effective treatment of compartment syndrome:
After the decompression fasciotomy, the patient is monitored closely for signs of swelling reduction and overall recovery. The incisions are left open to allow for any remaining swelling to decrease, and they are covered with appropriate dressings to protect the surgical site. The patient is usually returned to the operating room for wound closure once the swelling has subsided, which generally occurs within 24 to 72 hours post-surgery. Continuous assessment of the affected limb is crucial to ensure proper healing and to monitor for any complications that may arise during the recovery period.
| Short Descr | DECOMPRESSION OF THIGH/KNEE | Medium Descr | DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE | Long Descr | Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerve | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2013-01-01 | Changed | Medium Descriptor changed. Changed again per AMA corrections document. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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