# Mcbride bunionectomy



## daniel (Oct 13, 2008)

Procedures

1) Modified Mcbride bunionectomy, right foot

2) Partial ostectomy, proximal phalanx, right hallux

3) Closing base wedge osteotomy of proximal phalanx with internal #28 gauge wire fixation, right hallux.


How are these procedures coded.

Respectfully
Daniel, CPC


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## mbort (Oct 13, 2008)

G'morning Daniel,

It seems as though you have many posts requesting CPT codes.  I dont mind helping however it seems that you may be relying on the forum to do your coding for you.  I will offer my assistance and advice, however only if when you post your question, you also post what codes you are planning on using and not just "What are the CPT codes for this"?  

This forum is to help you learn and to direct you in the path to help you find your way...not do your job for you.

Sorry in advance if this offends you or anyone else 
Mary


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## daniel (Oct 13, 2008)

*Great response.*

mbort  
True Blue


Love the response, totally respect what was wrote. Have alot on my desk today. So just through these scenarios out on the threads to double check some questions I had.

For the procedures I posted on this thread. 

Would these be the correct codes.

CPT 28293-resection of joint with implant
      28306-osteotomy, with or without lenghtning, shortening or angular  
      correction, metatarsal: first metatarsal
      28288-ostectomy, partial, exostectomy or condylectomy, metarsal head, 
      each  metatarsal head


You can be brutally honest, that's how I learn. New to these OP reports. So I need all the input I can get to build on this side of the coding game.


Respectfully
Daniel, CPC


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## mbort (Oct 13, 2008)

all three of the codes you listed would be incorrect based on the summaries you provided.  

Are you coding from the top of the operative report?  Thats what these appear to be.


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## daniel (Oct 13, 2008)

Check it out.

OP Report.

Through further sharp and blunt dissection utilizing iris scissors, the primary incision was carried deeper to the level of the joint capsule where a capsulotomy was performed through 2 semi-elliptical incisions allowing access to the first MPJ. The ellipsed portion of capsule was passed off for pathological analysisi.


The joint capsule was reflected both dorsally and plantarly therby exposing the hypertrophied medial eminence of the first metatarsal head. At this time, utilizing the pneumatice sagittal saw, the redundant protion of bone along the medial aspect of the metatarsal head was removed and submitted for pathological analysis. Remaining sharp bone edges were then rongeured and finally rasped smooth. The site was copiously irrigated with sterile saline solution.

Following this procedure, a lateral capsulotomy was then performed through an intracapsular approach utilizing a #15 scalpel blade by distracting the hallux. Lastly , the lateral capsule and collateal ligament were freed up with the McGlamry elevator and the fibular sesamoid was released sharpley. Once this was accomplished, the first MPJ was able to be positioned in a more congruous position and the sesmoid apparatus was able to be shifted under the metatarsal head in a more correct alignment.

It could be seen that the hallux was still deviated lateally and therefore the decision was made to perform a closing wedge osteotomy on the proximal phalanx of the hallux. the primary incision was extended with a #15 scalpel blade in a distal fashion thereby exposing more of the base of the hallux which appeared hypertrophied and prominent medially. The incision was deepened down to the bone's cortex. The periosteum was reflected using a periosteal elevator and using the sagittal saw once more, the redundant portion of bone from the base of the phalanx was resected, rongeured and finally rasped smooth. 

A closing wedge osteotomy was then performed within th proximal base of the phalanx with the cut made from medial to lateral;
with the base of the closing wedge postioned medially and the apex directed laterally taking precatuions to keep the lateral cortex intact. A 1.5 mm drill hole was effected both proximally and distally to the osteotomy site and #28 gauge monofilament wire was then inserted across the site to secure it utilizing a crochet hook. The free braid was then fished back into the distal drill hole flush to the cortex of the bone. Following this procedure, joint range of motion was found to be adequate, the first MPJ appeared to be in excellent allignment, and the hallux was rendered rectus. 

Going off this. 

I'm coming up with this.

CPT codes: I've come up with 28298- Phalanx Osteotomy
                                         28306.59- osteotomy, with or without 
                                         lengthing, shortening or angular correction

                                         ,



I know this is a mouth full, but for those who are knowlegeable in this area, share your knowledgle out on this OP report I posed. It will highly be appreciated. I don't take the info I pick up here lightly. You'll be helping me start off in the right direction on these Podiatry Op reports. Learning this all on my own.

Respectfully
Daniel, CPC.

Oh yeah don't be shy to be brutally honest. That's how I learn.


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## Claudia Yoakum-Watson (Oct 13, 2008)

Daniel, Op notes can be tough to read and identify exactly what is being performed.  Your example is a good example of how complicated it can be.  

The first thing I would do is get a Coder's Desk Reference (CDR), if you don't have one. The CDR describes the pieces and parts of the code/service.  It would be very helpful here.  I don't have my CDR with me, so I can't be certain, but I can give you my thoughts. 

As you look at the op note, you will see that a lot is going on here. As I look at all the procedures documented in your op note, it appears to be pieces (elements) of a single bunionectomy. 

There are several different kinds of bunionectomies, all based on how and what is done. A bunionectomy can involve removal of capsules, seasmoids, the bony prominence of the medial head, one or more osteotomies, and some kind of fixation. 

The professional edition of the CPT manual has great pictures of some of the types of bunionectomies.  Again, I don't have my CDR so I'll wait to see what you come up with, but I'm pretty sure one code will represent what is documented in your op note. 

Any other thoughts out there on this one?


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## daniel (Oct 14, 2008)

*Thanks for the added input.*

Claudia Yoakum-Watson  
Contributor


Overlooked the idea of getting a Coder desk reference. I'll go get an updated one today.

Respectfully
Daniel, CPC


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