A seven-year-old boy diagnosed with left distal femur osteosarcoma underwent surgery. The surgeon resected 18 centimeters of the distal femur and the entire knee joint down to subcondylar bone on the tibia. Following resection of the left distal femur osteosarcoma, left femur to left tibia rotational osteosynthesis was performed. The tibial component was rotated 180 degrees and a plate was attached on the lateral side of the femur and the rotated medial side of the tibia (rotated 180 degrees so it has become the lateral side). The tibia was fixed first onto the plate with screws, and after the screws were placed into the femoral side, rotation was confirmed. What is the correct root operation for the left femur to left tibia rotational osteosynthesis?
This surgery is most often performed to treat children with bone cancer in the distal femur or proximal tibia. At surgery, the malignant neoplasm and surrounding tissues are removed and the remaining lower section of the leg is rotated back to front, then reattached to the healthy upper section so that the ankle joint bends forward somewhat like a knee, and a lower leg prosthesis can be attached to the foot to make up the difference in leg length. The appropriate root operation for the rotational osteosynthesis is “Reposition,” and the repositioning of the tibia captures the rotational osteosynthesis. In ICD-10-PCS, the root operation “Reposition” is defined as moving to its normal location or other suitable location all or part of a body part. This is not a knee replacement procedure per se. Instead, the ankle is temporarily taking the place of the knee while the child’s long bones continue to grow, after which the knee will be reconstructed, a knee replacement procedure will be performed, and the ankle joint will be returned to its normal anatomical position. Assign the following ICD-10 PCS codes:
0QSH04Z Reposition left tibia with internal fixation device, open approach
0STD0ZZ Resection of left knee joint, open approach, for the resection of the knee joint
0QTC0ZZ Resection of left lower femur, open approach, for the resection of the distal femur