# Tibial & Fibular sesamoidectomy



## karenwebb

I'm trying to find this code. Doctors originally did an I & D and decided to do both a tibial and fibular sesamoidectomy. I have come across this before but I was confused on the previous.


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## PICFLORIDA49

*sesamoidectomies*

I am also needing to know how to code an I&D with tibial and fibular sesamoidectomies.  Please let me know if you find out anything.  Thanks.


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## Jamie Dezenzo

could you post note?


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## PICFLORIDA49

*I&D with Fibular Tibial Sesmoidectomies*

PROCEDURE IN DETAIL:  Under mild sedation, the patient was brought to the operating room and placed on table in supine position.  Pneumatic tourniquet was placed about the patient's right ankle.  Following general anesthesia, local anesthesia was obtained throughout the patient's right foot utilizing 0.5% Marcaine plain.  The foot was scrubbed, prepped and draped in usual aseptic manner.  An Esmarch bandage utilized to exsanguinate the patient's foot and the pneumatic tourniquet was then inflated.  

Attention was then directed to plantar aspect of the right foot where the area of previous drainage was noted.  This area was dissected and elongated with resection of ulcerative tissue.  This incision was carried down to the fibular sesamoid where there was noted inflammatory tissue within the plantar aspect of the right foot.  The fibular sesamoid was identified.  It was significantly hypertrophied and degenerated.  This was resected from its surrounding soft tissue structures and passed off the operative field and sent to pathology for both gross and microscopic examination as well as cultures taken.  

At this time, the decision was made to resect the tibial sesamoid secondary to the fact that this will be cause of increased pressure in the future especially with respect to the fibular sesamoid and the patient's long history of current resections and ulcerations.  This was done without incident.  Upon completion of the procedure, the area was flushed with pulse lavage with 1 L with bacitracin followed by appropriate closure.  There was an area that was unable to close.  This was packed with half-inch Iodoform gauze to be removed by myself in my office.  Appropriate dressings were applied, followed by release of the pneumatic tourniquet and hyperemic response to the remaining stump of the right foot.


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## Marie Martin

*tibial sesamoidectomy*

Hope this helps.  Found my answer elsewhere.  Use CPT code 28315.


Patho-Anatomy:
- turf toe
- sesamoid fractures
- hallux valgus
- because the sesamoids are eembedded in teh tendon of the FHB, which inserts into the base of the proximal phalanx, any degree of hallux valgus tends to rotate both sesamoids on the long axis;
- fibular sesamoid tends to rotate into the 1st metatarsal interspace, thereby disposing of the possibility of its becoming a wt bearing focus;
- tibial sesmoid rotate on its side & thus become wt bearing pivot;
- sesamoiditis


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