# Is K wire included in 28285????



## Sage123 (Jan 20, 2012)

Wondering if someone can help me.

Here are the codes I've selected but per coder's desk reference does not state anything to do with K wire. Is K wire included in 28285? Plus do my codes look about right?
Please and thank you for any help.

28292-LT 735.0
28285-59-T1, 735.0
28295-59-T2, 735.0
28295-59-T3, 735.0


POSTOPERATIVE DIAGNOSES: Hallux valgus left foot, hammer toe deformities
second, third and fourth toes all of the left foot.

PROCEDURE:
1. McBride bunionectomy left foot.
2. Hammer toe correction second, third and fourth toes of the left foot.


OPERATIVE TECHNIQUE: The patient was brought to the operating room and
placed on the operating room table in the supine position with an IV
intact for intravenous sedation. The patient was given 2 grams of Kefzol
for routine orthopedic prophylaxis.  The left foot was prepped and
draped in the usual aseptic manner and then exsanguinated with an
Esmarch bandage. Hemostasis was maintained with an ankle pneumatic
tourniquet inflated to 250 mmHg.

Attention was directed to the dorsal aspect of the left foot where an
approximately 5 cm linear skin incision was performed just medial to the
extensor hallucis longus tendon. The incision was deepened down through
subcutaneous tissue, taking care to coagulate venules and retract
neurovascular structures. A linear capsule and periosteal incision was
performed and the capsular and periosteal tissue reflected from the
medial aspect of the first metatarsal head exposing hyperostosis into
the surgical site. The hyperostosis was resected with the sagittal saw,
taking care to protect the sagittal root plantarly.  Attention was then
directed to the first interspace where dissection was carried out down
to the level of the fibular sesamoidal bulge. The fibular sesamoid was
identified and then freed on all sides until erectus position of the
great toe, allowed the sesamoid to glide back beneath the metatarsal
head. All remaining adductor tendon fibers were also transected at that
time.  The site was irrigated with copious amounts of sterile normal
saline. All bony edges were smoothed. The capsular tissue was
reapproximated with 2-0 and 3-0 Vicryl sutures, subcutaneous tissue with
4-0 Vicryl suture and the skin incision with 5-0 Vicryl subcuticular
suture.

Attention was then directed to the second toe, identical procedures were
performed on the second, third and fourth digits.

The 2 converging elliptical incisions were performed over the proximal
interphalangeal joint. The intervening skin was excised in toto. The
incision was deepened down to the extensor tendon. Care was taken to
retract neurovascular bundles on each side. A transverse tenotomy and
capsulotomy was performed at the proximal interphalangeal joint. The
head of the proximal phalanx was resected in a Chevron type fashion, as
well as resection of the base of the middle phalanx. The toe remained
contracted at the metatarsal phalangeal joint, thus an extensor hood
release was performed as well as dorsal medial and lateral capsulotomies
at that level. This allowed the toe to sit in a rectus position. A K-
wire was integrated out the tip of the toe, and then retrograded back
across the proximal interphalangeal joint to the metatarsal phalangeal
joint level. The extensor tendon was reapproximated with 4-0 Vicryl
sutures, subcutaneous tissue with 4-0 Vicryl suture and the skin was
closed with 5-0 Vicryl subcuticular suture.


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## christinnagle (Jan 21, 2012)

Yes, the K wire is inclusive in the Hammertoe repair. The K-wire stabilizes the repair and removal will be inclusive in procedure. I agree with your code choices. Dx codes: Hammertoe vs HV I use 735.4 for hammertoe unless physician notes some congential issue. But I'd like to have a 2nd opinion.


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## armen (Jan 21, 2012)

We never bill for K wire or any screws/pins its always included in the procedure.


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## Sage123 (Mar 8, 2012)

Thank you for the help.


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