Ask Dr. Z

We're looking to find out when it is appropriate to bill 27592 vs. 27590 for an AKA, first operation. "Standard anterior-posterior fishmouth type incision was made justt above the knee. This was carried through skin, sub-q tissue, and through crural fascia muscle layer. All muscular tissue was transected using electorocautery surround the femur. We then identified the popliteal arter and ven and ligated artery and vein with silk sutures. We then ligated distally as well and transected them. Next, we completed our posterior circumferential transection of muscles and tendons around the femur. Finally the sciatic nerve was ligated high in the field and then cut high in the filed and allowed to retract back. I then made another cut anteriorly on the femur with the oscillating saw to create a bevel to avoid any compression. A rasp was used to file down the edge of the femur so it was not sharp. I then irrigated and achieved full hemostatis. I buried the popliteal artery and vein stumps. We then closed in layers."