# Instep exostosis



## elenax (Nov 15, 2007)

Can anyone help with a cpt code for instep exostectomy of the foot?


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## mbort (Nov 15, 2007)

*More info*

need more info


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## elenax (Nov 15, 2007)

NELENAZ said:


> Can anyone help with a cpt code for instep exostectomy of the foot?





 The scenario is a follows:

Attention was first directed to the left instep. Using a #15 blade, we made about a 3 to 3.25 cm incision, encompassing this bony exostosis. We went down with a fresh #15 blade, all superficial vessels were cauterized as necessary. We went down to the capsule, incised the capsule, and worked our way a little more laterally. We kept our incision away from the extensor hallucis longus tendon, though needed to go near that structure to access the instep, exostosis. But to decrease scarring to allow for better motion, we made our incision just about 1 cm medially, working our dissection to the area. We went down, used a curved osteotome, about 8 mm and 10 mm, and remodeled the area meticulously. I used a power rasp, and flushed and suctioned copiously with sterile saline. I inspected for bleeders, and there were none. We closed the deep structures with 3-0 Vicryl in simple interrupted undyed, and the subcuticular in 4-0 Vicryl undyed, and the skin in 4-0 Prolene in simple interrupted fashion.


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## mbort (Nov 15, 2007)

since the instep is the arched area between the toes and ankle, I would think that he was removing the exostosis from a metatarsal bone (28104) but based on the documentation, I think I would query the physician for additional info.

Hope this helps


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## elenax (Nov 15, 2007)

Thank you.  I have feedback from another coder that agrees with you.


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