# Nonunion metatarsalphalangeal joint repair;  HELP!



## joanne71178 (May 23, 2013)

I am having a difficult time finding the correct code for this surgery.  The office wants to code 28124, but that is for Osteomyelitis. 

I was considering 28322-52 or 28294-52

POST OP DIAGNOSIS:  
Right foot metatarsal phalangeal joint proximal phalanx avulsion nonunion

OPERATION PERFORMED:
1. Excision of nonunion
2. Repair of the metatarsal phalangeal medial ligament

" After general anesthesia the patient was prepped and draped in the usual sterile fashion.  The patient had an avulsion fracture at said joint 6 months ago.  She had been treated with cast and fracture boot and at times she removed these and it simply has not healed.  Our decision has been made to excise the nonunion piece of bone and repair of the ligament.  A longitudinal incision was made at the metatarsal phalangeal joint.  sharp dissection was carried through the skin.  The ligament was divided longitudinally.  We subperiosteally dissected out the avulsed large piece of bone and repaired the ligament back to its insertion site.  The wounds were copiously irrigated.   A layered closure ensued.  The wounds were dressed.  The patient was taken to the recovery room in stable condition."


Thanks in advance!


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## Laxwido (May 23, 2013)

Good Morning!  I've only had 1 cup of coffee, but I will take a stab at this one!  28124 is not just for osteo, and in this case I feel is better than the 28322, even with the 52.  Unlisted is always an option, maybe go unlisted, write a letter and compare to 26516 or 26540 (MCP capsule/ligament repair)?  We set our price per the RVU's of our comp code.

Any other thoughts??..??..


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