Using ICD$-10-$PCS$,$ code the following procedure.

Important: This procedure requires two codes. Enter the first code in this question. Enter the second code in the separate question below.

Case Study #$3$:

Do not code the fluoroscopic guidance or x$-$rays for this case.

PREPROCEDURE DIAGNOSIS: Schatzker type $6$ left tibial plateau fracture

POSTOPERATIVE DIAGNOSIS: Schatzker type $6$ left tibial plateau fracture

PROCEDURE PERFORMED: Open reduction internal fixation of left tibial plateau fracture with removal of spanning external fixator

ANESTHESIA TYPE: General.

ESTIMATED BLOOD LOSS: Less than $10$ mL$.$

SPECIMENS: None.

COMPLICATIONS: None.

INDICATIONS FOR SURGERY: The patient with the above diagnosis who was a pedestrian versus motor vehicle approximately three weeks ago. The patient was initially treated by another physician. He also presented with a compartment syndrome. Emergent fasciotomies were performed and he was placed in an expanding external fixator. The patient had a repeat washout a week later by myself with primary wound closure of his fasciotomies. He was discharged from the hospital to allow for soft tissue swelling to decrease. Once the swelling had adequately been reduced and he had a positive wrinkle sign, he was brought back for definitive reduction and fixation of his tibial plateau fracture. Risks and benefits of the procedure were explained to the patient and he made an informed decision to proceed with the above recommended procedure.

DESCRIPTION OF PROCEDURE: The patient was seen preoperatively. The left lower extremity was marked. He was brought to the operating room and given a general anesthetic, placed supine on the Jackson table. A tourniquet was placed on the patient's thigh and was inflated to $300$ mmHg$.$ Tourniquet time was $120$ minutes. Once the leg was sterilely prepped and draped in standard orthopedic fashion, universal protocol with time$-$out was taken to confirm that the left lower extremity was the correct operative site. Once that was done, the leg was elevated and the tourniquet was deflated. The fixator was brought in$.$

Prior to the leg being prepped, intraoperative fluoroscopy was brought in to confirm area of the reduction. The patient was slightly distracted so the two of the fixator bolts were loosened and the traction was taken down, shortening some of the gap in the metaphyseal region and then re$-$tightened and prepped. Once the leg was sterilely prepped and draped and time$-$out was taken, to size of the plate was measured. A Synthes $12-$hole, $4/5$ periarticular locking plate was used and was measured for the appropriate length. The joint line was identified and a $3\mathrm{.}5$ to $4$ cm curvilinear incision was made proximally at the level of the joint line. Dissection was carried down to the skin and subcutaneous tissue to the fascia as one large flap down to the bone and elevated for placement of the plate. A Chandler elevator was then used to elevate down the outside of the shaft of the tibia for reduction and placement of the plate.

Once the plate was placed in appropriate position and confirmed on orthogonal views of intraoperative fluoroscopy, the guidewires were placed, three across the top proximally for the rafting screws and then one distally locking through the plate, forming our box construct. Once it was confirmed that the plate was in appropriate position, a large periarticular reduction clamp was used to go across the intercondylar split, reducing the intercondylar split. Then a whirligig was placed through the $7$ hole of the plate, sucking the plate down to the bone. Once that was done, a nonlocking $4/5$ cortical screw was placed in the $8$ hole slot and then four distal locking screws were placed, one through the $12,11,10$ and $9$ holes. The rafting screws, three cannulated locking screws, were placed. They were measured off the guidewires which confirmed that they did not violate the knee joint and were the appropriate length. Once that was done, the three screws were placed. The kick stand screw was placed. A locking screw through the guide and then another $6/5$ nonlocking, partially$-$threaded cancellous screw was placed for a second kick stand screw through the metaphyseal oblique screw holes, getting another screw into the medial tibial plateau. It was drilled, measured and appropriate screw was placed. Once that was done, the external fixator was taken off through an external approach.

$.$

The knee was put through range of motion. Final radiographs were taken which showed restoration of the articular surface and actual aligning of the tibia, noting the reduction as successful. Appropriate screw lengths, appropriate plate placement and appropriate screw placement. The comminution of the metaphyseal area was treated with a bridge$-$plating technique. No screws were placed through that area which would not have gotten much purchase for the screws. Once that was done, Steinmann views were taken.