# Tailor's bunionectomy



## katiejeanne (Dec 30, 2013)

Our surgeon did a Tailor's bunionectomy with screw fixation and extensor tenotomy, right 5th MPJ. It also says that there was still a deforming force laterally and plantarly so an osteotomy was then performed, an Austin type, in the 5th metatarsal head and neck area.

A Tailor's bunionectomy comes up with CPT 28110 but that is an add-on code only. So I was typing Austin bunionectomy with osteotomy into 3M but that gives me 28296 which is for the 1st metatarsal head. It appears a tenotomy would be included in 28296 but not necessarily 28110. What code(s) would you use for this procedure?? I'm really stuck on this one. The scrubbed note is below, thanks!!!


POSTOPERATIVE DIAGNOSIS:  	
	1. 	Tailor's bunion, right foot.
	2. 	Mild subluxation, right fifth MPJ.

PROCEDURE:  Tailor's bunionectomy with screw fixation and extensor tenotomy, right fifth MPJ.

OPERATIVE NOTE:  ....at this time, a linear incision was placed just lateral to the extensor tendon.  The incision was bluntly dissected down through subcutaneous tissue, cauterizing all bleeders encountered, retracting all neurovascular structures as encountered.  Due to the subluxation and increased risk of subluxing after the Tailor's bunionectomy, the extensor tendon was identified and was sharply transected.  This allowed for good realignment of the fifth digit on the fifth metatarsal head.  An enlarged lateral exostosis was noted.  This was sharply transected with the sagittal saw.  Prior to this, the incision was deepened down through the capsule and periosteum and all capsule and periosteum was reflected off the fifth metatarsal head.  At this time, there was still a deforming force laterally, as well as plantarly, and some pressure to the fifth MPJ, so an osteotomy was then performed, an Austin type, in the fifth metatarsal head and neck area.  The capital fragment was shifted over medially approximately ¼ the width of the metatarsal.  The first attempt to fixate with the 2.4 mm screw did not show any bite or tightness, as there was possibly a cyst or it did not have good purchase, so the screw was then inserted more proximally into more cortical bone and had good purchase and good tightness.  There was no looseness to the osteotomy.  The redundant shelf of bone medially was then transected with the sagittal saw.  The bone piece was removed.  The area was flushed with copious amounts of sterile saline.  The deep capsular layers were re-approximated with 3-0 Vicryl.  Skin incision was re-approximated with 4-0 nylon.  A well-padded sterile dressing was applied to the right foot.  The tourniquet was released with immediate hyperemic flush to all digits to her right foot...


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