# Medial sliding calcaneal osteotomy with lateral column lengthening



## gsteeves (Feb 21, 2013)

Good Afternoon,

Dr performed a lateral slding calcaneal osteotomy along with a lateral column lengthening, need help with CPT code. 

Lateral sliding calcaneal osteotomy was performed through an obliquely oriented incision made over the lateral wall of the calcaneus. The incision was carried down through the skin only with a #15 blade knife. Deep dissection was performed by spreading and cutting with a pair of Converse scissors and the lateral wall of the calcaneus was identified. Hohmann retractors were placed dorsal and medial and a high speed micro sagittal saw was used to osteotomize the posterior tuberosity transversely. It was shifted 1 cm medialward and slightly distalward and transfixed with two guidewires from the Arthrex 6.5 mm cannulated screw set from posterior to anterior. A short longitudinal incision was made posteriorly and each of these two guidewires were advanced. Image intensification on AP and lateral views confirmed adequate medial translation of the osteotomy as well as desired guidewire placement. Over drilling was performed and counter sinking was performed. Two 6.5 mm screws were placed compressing the osteotomy in the desired position. A crushplasty of the lateral wall of the calcaneus was performed with a small bone tamp and the guidewires were withdrawn. 

Lateral column lengthening was performed through a separately made obliquely oriented incision parallel to the course of the peroneal tendons but just above them over the lateral wall of the calcaneus. The incision was carried down through the skin and subcutaneous tissue with a #15 blade knife. Deep dissection was performed by spreading and cutting with a pair of Converse scissors to avoid injuring the sural nerve. A longitudinal incision was made directly dorsal to the peroneus brevis tendon directly down to bone. Soft tissues were elevated dorsal and plantar off the lateral wall of the anterior body of the calcaneus. With Hohmann retractors placed dorsal and plantar a micro oscillating saw was used to obliquely osteotomize the anterior body of the calcaneus between the middle and anterior facets. The osteotomy was gently distracted using a lamina spreader and a allograft wedge was placed. A 5 mm cortical length allograft wedge cut from a femoral neck allograft was placed. A four hole Wright Medical Pia Evans osteotomy plate was then placed. It was transfixed to the lateral wall with a total of three locking screws. The most dorsal of the screws could not be placed due to potential for interference in the subtalar joint. The osteotomy was felt to be stable and we then performed the tendon reconstruction. 

I have 28300 but would like another opinion.

Thanks in advance for your help.
Gail Steeves, CPC


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## woowooz7 (Dec 1, 2014)

Hi gsteeves. Did you ever find your answer?  I'm having a difficult time coding this same scenario myself.

Thank you.


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## PLAIDMAN (Dec 2, 2014)

you can only charge this code 1 time for same bone 

you will see in your cpt book, 28300 says "Dwyer or Chambers type" - there are other types as well, but for example the Dwyer technique includes multiple cuts and sometimes some tendon work

if the Dr had to do extra work to correct the deformity, this difficulty should be documented as well as the additional time it took, then you can add the "22" mod.


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## woowooz7 (Dec 3, 2014)

Thank you Plaidman.  I'm new to foot surgeries so this was helpful.


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