# Help with foot procedure



## smcbroom (Nov 24, 2008)

OK, so I know I'm probably reading this and making it seem harder than it is but can anyone assist me with the codes for this.  I'm  thinking 28124 & ??? but not totally sure.  I work for an ASC and it's a commercial payer.

PREOPERATIVE DIAGNOSES:
1.  Exostosis of bone left great toe involving the medial epicondyle of the head of the proximal phalangis and the medial base of the distal phalangis.
2.  Loose body or fracture fragment dorsomedial left hallux interproximal joint.

POSTOPERATIVE DIAGNOSES:
1.  Exostosis of bone left great toe involving the medial epicondyle of the head of the proximal phalangis and the medial base of the distal phalangis.
2.  Loose body or fracture fragment dorsomedial left hallux interproximal joint.

SURGICAL PROCEDURES:
1.  Exostectomy of the medial base of the distal phalangis of the left great toe.
2.  Exostectomy of the dorsomedial epicondyle of the head of the proximal phalangis of the left great toe.
3.  Excision of loose body of dorsomedial capsule left great toe at the level of the IP joint through to be a fracture fragment.
4.  A regional nerve block using 0.5% Marcaine with epinephrine.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room having been prophylaxed with 1 g of Ancef IV preoperatively.  She was given a general anesthetic in a supine position.  The left lower limb was prepped and draped in the usual sterile manner and elevated for 3 minutes, after which a pneumatic tourniquet was inflated about the left ankle.  I exsanguinated the extremity with an Esmarch bandage.

A 3-cm serpentine incision was created from distal medial to the dorsal lateral over the medial epicondyle at the head of the proximal phalangis.  There was marked hyperkeratosis noted over the medial epicondyle.  The skin wound was deepened through subcutaneous tissue down to the capsular structures of the left hallux IP joint.  A linear capsulotomy was performed over the dorsomedial aspect of the joint.  A rather large loose body was freed up from its fibrous attachment within the joint capsule.  I then performed a capsulotomy opening the joint reflecting the extensor hallucis longus tendon making sure that its insertion was intact.  I remodeled the dorsomedial aspect of the medial epicondyle of the proximal phalangis of the left great toe as well as the base of the distal phalangis where an exostosis was trimmed off medially.  The cut portions of bone were smoothed with a reciprocating rasp.  The wound was then copiously flushed with sterile saline.  Cartilaginous erosion within the left hallux IP joint was noted and this was thought to be related to an old fracture of the left great toe.  All bone paste was pumped free of the surgical wound site.  I then palpated the wound noting no further hyperostosis noted.  The capsulorrhaphy was then repaired using 4-0 Vicryl and the subcutaneous closure made in like manner.  The superficial wound was closed using horizontal mattress sutures of 5-0 Ethilon.

The pneumatic tourniquet was deflated and normal digital perfusion reoccurred spontaneously.  A regional block using 0.5% Marcaine with epinephrine was administered.  The surgical wound was dressed with Xeroform gauze, sterile gauze sponges, ABD bandage, and a Kling and Coban wrap.  The patient was placed in a postop shoe.  Good digital perfusion was seen following the surgery at the time our tourniquet deflation was noted.  I made sure the extensor hallucis longus tendon insertion was intact.  The patient was taken to the recovery room in satisfactory condition.

Your input is greatly appreciated!


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## mbort (Nov 24, 2008)

it also looks like there may be a capsulotomy in there as well as an arthrotomy with removal of loose body (it states it was in the joint). HOWEVER with that being said, I have not looked at any CCI edits though.


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## smcbroom (Nov 25, 2008)

Thanks Mary!


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