# Charcot Foot Deformity Sx



## orthopaedic01 (Jan 4, 2010)

Can someone please help me with coding the following Sx:?

Dx: Charcot foot deformity

Procedure: Major closing wedge osteotomy, left mid foot
                Percutaneous tendoachilles lengthening

Description:  Incision made over the medial mid foot, carried through subcut. down to bone.  The mid foot was exposed both dorsally and plantar with subperiosteal dissection using an elevator.  Two steinman pins were driven across the mid foot, one at the base of the metatarsal and the other through the mid cuneiform.  The pins were angled in such a way such that a closing wedge would bring about a neutral alignment to the foot.  Once acceptable placement of the pins were achieved on the c-arm images, Cobra retractors were placed and an oscillating saw was used to resect a transverse wedge of bone across the entire mid foot.  The wedge was removed.  The osteotomy was closed and provisionally pinned with a 2 mm pin.  Images on c-arm revealed excellent correct of the deformity in both ap and later views.  Bone morphogenic protein soaked sponges were packed around the osteotomy site and also within a cavitary lesion of the proximal first metatarsal.  The osteotomy was fixed with a 5 hold fibular plate using locking screws.  Placement of the hardware was confirmed on c-arm.  The wound was irrigated thoroughly and a Hemovac drain was placed in the plantar cavity.  The wound was closed in layers.  
Next, a 15-blade was used to perform a triple hemisection perct. tendoachilles lengthening in standard fashion.  The cuts were made distal lateral, middle medial, and proximal lateral.  The foot was dorsi flexed t 90 degrees and a dry sterile compresssion dress. and splints were applied.

I'm having trouble with the major closing wedge midfoot osteotomy. 28309 is for multiple metatarsal osteotomies, but does not address the plates/screw fixation.  What do you think about 28735, Arthrodesis midtarsal or tarsometatarsal, multiple or transverse with osteotomy?

Thank you for your thoughts!


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## BCrandall (Jan 6, 2010)

Per the Coder's Desk Reference, CPT 28309 states "Multiple fixation devices such as screws, plates or pins are applied to hold the bones in their new positions."

Hope that helps.


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