# keller arthroplasty



## BFAITHFUL (Oct 20, 2008)

Hi everyone

i have an op report that states keller arthroplasty/bunionectomy and exostectomy lateral and proximal aspect of distal phalanx.  im using cpt 28292 for keller arthroplasty but surgeon's ofc is using 28285 for the exostectomy isnt this code only for the lesser toes 2nd-5th digit not for big toe?


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## Claudia Yoakum-Watson (Oct 20, 2008)

BETSYRIVERA said:


> Hi everyone
> 
> i have an op report that states keller arthroplasty/bunionectomy and exostectomy lateral and proximal aspect of distal phalanx.  im using cpt 28292 for keller arthroplasty but surgeon's ofc is using 28285 for the exostectomy isnt this code only for the lesser toes 2nd-5th digit not for big toe?



I'm a little confused.  The 28292 is a bunionectomy.  The 28285 is a hammertoe release, which most of the time, but not always is on the lesser toes.  If I recall my medical terminology, the exostosis is a bony growth.  This would be consistent with a bunionectomy. Can you provide the body of the op note?  I'd be happy to take a look at it.


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## BFAITHFUL (Oct 20, 2008)

yes see following,  (thanks)

linear incision approximately 6 cm was directed over the first MTP and extending mid shaft to the proximal phalanx.  The incision clamped, ligated and retracted accordingly.. It was noted that there continues to be some sewage into the area and the capillary return was noted to still be coming back.  At thisp oint, the procedure was temporarily suspended and foot elevated for using and Esmarch drain applied.  The tourniquet was elevated to 275 mmHg, which improved the situation, but there was still some sewage in the area.  This is probably due to either calcified vessels or the use of the medicines for patient's post kedney transplant.  The capillary return was still noted in the digits, but decreased, but the surgery was resumed at this point.  

The incision was deepened down to the level of the first MTP capsule.  A linear capsulotoy was performed.  The soft tissue attaching to the headof t he metatarsal was freed of dorsally, medially, and plantar medially.  At this time, the incision was deepened thru the mid shaft of the proximal phalanx.  All soft tissue attachments were removed from the base of proximal phalanx both medially and latrally.  The EHL tendon was retracted laterally.  Using a sagittal saw, the exostosis of the first metatarsal was removed and the area was smoothed.  At this point, a sagittal saw was applied to the distal one third of the proximal phalan, which was removed in toto.  The area was flushed with sterile saline.  Attention was drawn to the lateral aspect of the IPJ, where a stab incision was made distally at the distal lateral aspect and deepened down throughthe level of the bone using a periosteal elevator and a Beavor blade.  The bone was well identified in the area.  Using a reciprocating rasp, the lateral exostosis was removed and rasped smooth and flushed with sterile saline.  Immediate xrays were taken and the good results with the lateral aspect of the distal phalanx removed as compared to the preop x rays.  A 0.062 k-wire retrograded through the hallux and into the metatarsal head to keep the joint space intact.     

what u think??

maybe it all just falls under cpt 28292


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## Claudia Yoakum-Watson (Oct 21, 2008)

I think you are correct.  In my opinion, you have 28292.  Although you mentioned it was a Keller, it involved some soft tissue and ligament release, which is similar to a Mayo.  Regardless, they are both code 28292. I've underlined the key words I used to determine this.  Although a capsulotomy was performed, it is considered a component of the bunionectomy and not reported separately

If you look at the Keller diagram below CPT Code 28292 in the Professional Edition of the CPT Manual, you can see where the exostosis of the first metatarsal was removed on the outside of the big toe.  You will also see where they used they remove the distal one third of the proximal phalanx.  

I usually see the phrase “bony prominence” instead of exostosis, but they are the same thing. I hope this is helpful.  Anyone else have thoughts on this?


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