# Oblique osteotomy please?



## BFAITHFUL (May 15, 2011)

This is my third request.    Does anyone know what cpt code to use for an oblique osteotomy of metatarsal head.  Is it 28296?  It was done for hallux limits.   

Thank you


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## maryanneheath (May 17, 2011)

Hi, I am certainly no foot expert, but I think that 28306 may be a more appropriate code, unless your physician has specified that he has done a Joplin procedure.


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## jdemar (May 18, 2011)

Your original question is unclear as to what the primary procedure code is and what was done.  A partial posting of the operative note is helpful.  If the patient only had an osteotomy then the 28306 (1st metatarsal/28309 other than 1st) would be correct, but if your phycisian performed a correction of hallux valgus with metatarsal osteotomy and in you reviewing your note, see if 28296 is more appropriate....it is for correction hallux valgus with metatarsal osteotomy -1 code, both procedures are included.


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## BFAITHFUL (May 18, 2011)

It was for a hallux limitus condition.  See the following op report. Thank you both. 

Xray showed bony prominence on the first metatarsal head on lateral view as well as dorsiflexory tendency of the first metatarsal upon the hallux. 

L type capsulotomy was performed over dorsal aspect of the first metatarsal head. Utilizing a sagittal saw, the does medial prominence encountered at the first metatarsal head and then resected and passed from the operative field. Using a guide wire the shaft of the metatarsal was pinned from medial to lateral and an osteotomy was placed to perform an oblique cut on the first metatarsal shaft. The cut was made from dorsal distal to plantar proximal in an oblique fashion. Next the capital fragment was repositioned and the metatarsal was noted to be in a more corrected anatomical position by being more plantar and distal than the original position. At this point the hallux was placed and the first MPJ was put through a series of range of motion and an increase of dorsiflexion was noted. Attention directed to the dorsal aspect of metatarsal where a guide wire was placed from dorsal to plantar followed by a vilex screw. Then utilizing a kwire the most medial aspect of the osteotomy was fixated and the kwire was cut and buried into the metatarsal shaft. At this time the peri steal and capsular structures were reap foci aged.


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## BFAITHFUL (May 19, 2011)

Any takers on this?


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## dadhich.girish (May 20, 2011)

After going through the op report, I strongly agree with 28306.


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## BFAITHFUL (May 20, 2011)

*oblique osteotomy please?*

can you explain what made you choose between 28306 & 28296?  thank you


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## PLAIDMAN (May 20, 2011)

Sorry to throw a wrench but I would use 28296.  I think he is obviously doing more than just an osteotomy, he resected the medial eminence and corrected a deformity.  You CAN use the bunionectomy codes for other deformities, I have asked "experts" (at seminars) this question and I have also asked a couple of my payors.

Just because he doesnt say the words "hallux valgus" or "bunion" does not mean you cannot use those codes.  My definition of "hallux valgus" is a deviation of the toe, well I think the op clearly states that there is a deformity(a deviated toe would = deformity)

I am sure that not everyone will agree with me......but.........I say 28296


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## BFAITHFUL (May 21, 2011)

Plaidman- when can we use 28306/28309? For what for what kind of condition?

Thank you


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## PLAIDMAN (May 23, 2011)

My docs/I will use these codes when the osteotomy is the only thing being done(or not included in other proced) 

any deformity of toe or metatarsal, aquired or congenital
hypermobile metatarsal
displaced metatarsal
metetarsalgia
other bone damaging arthritis'
large exostosis
28308=for tailor's bunion (includes ostectomy)

28306,usually for the 1st met my docs are doing some sort of hallux deformity correction, so it maybe included in those codes.

There actually is a difference between a "bunion" and "hallux valgus" (varus)- I do have some articles from AAOS by Margie - I could dig them up, you can send me private message with your fax#


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## BFAITHFUL (May 23, 2011)

ok.... will do.... 


thanks a million!!!!!!


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