# hemiphalangectomy? please help



## BFAITHFUL (Apr 10, 2012)

Not sure which codes to use for the following:  28126, 28153 or 28160?  Thanks


DX: Painful exostosis of head of proximal phalanx of left great toe & Painful exostosis of the base of the distal phalanx of the halllux of left great toe

Procedure:  Hemiphalangectomy at the left hallux proximal phalanx 
                  Hemiphalangectomy at the left hallux distal phalanx


GROSS FINDINGS:
Examination of the left foot shows that there is exclusively painful hyperkeratotic lesion at the medial aspect of the IPJ of the left hallux.  We have tried multiple forms of conservative therapy including padding, strapping, orthotics, and tractions, all of which failed to alleviate her pain.  X-ray showed that there is hypertrophic condyle at the both sides of the joint of the IPJ of the left hallux.  She understands the need for this procedure, possible risks, benefits, complications, and alternatives and consents to procedure listed above.

OPERATIVE PROCEDURE:
After obtaining an informed consent, Mrs. M was taken to the operating room and placed on the OR table in supine anatomic position and positioned for the administration of local anesthesia.  She received a total of 10 cc of 0.5% Marcaine plain.  The block was used in conjunction with intravenous sedation.  The left limb was prepped and draped in the usual sterile fashion for surgery.  Following elevation for three minutes, a well padded sterile ankle tourniquet was inflated to 250 mmHg.  The limb was lowered to the level of the table and the following procedure was performed.


Attention was directed to the medial aspect of the IPJ of the left hallux, where an approximately 3 cm long linear incision was created.  The incision was deepened within the same plane taking care to avoid all neurovascular structures.  A linear capsular incision was created.  The capsule was reflected medially and laterally.  The head of the proximal phalanx, as well as the base of the middle phalanx were freed from all soft tissue attachments dorsally, medially, and plantarly with the use of a power sagittal saw.  The hypertrophic condyle of both the base of the distal phalanx and head of the proximal phalanx were resected.  At this point with the use of hand rasp, the remainder of the plantar aspect of the joint was rasped and smoothed.  The site was flushed with copious amounts of normal sterile saline.  Deep closure was achieved with 3 0 Vicryl and skin margins were re approximated with 4 0 nylon.  The site was dressed with sterile Adaptic, sterile 4x4s, sterile Kling, and an Ace bandage.  Upon deflation of the pneumatic tourniquet, there was normal hyperemic flush seen to profuse all digits of the left foot.  Marypat tolerated the procedure and anesthesia well without complications with minimal blood loss and was transferred to the recovery room in satisfactory condition with vital signs stable.


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