# Opinions Please - The patient was brought



## ckkohler (Apr 25, 2009)

*Looking for an opinion on the correct diagnosis for this OP report as I disagree with the answer in the practicum:*

*PREOPERATIVE DIAGNOSIS:* Hammertoe deformity, fifth digits bilaterally.

*POSTOPERATIVE DIAGNOSIS: *Hammertoe deformity, fifth digits bilaterally.

*PROCEDURE PERFORMED:* Middle phalangectomy and condylectomy, fifth digits bilaterally.

*DESCRIPTION OF PROCEDURE: *The patient was brought to the operating room and placed on the operating table in the dorsal recumbent position. Anesthesia was obtained with the use of a total of 8 cc of equal parts 2% plain lidocaine and 0.5% plain Marcaine instilled to form a complete digital block to the fifth digits bilaterally. Monitored anesthesia care was also administered and utilized by Dr. The patient's left and right foot and leg were then prepped and draped in the usual aseptic manner. Hemostasis was obtained with the use of a Martin's bandage to and above the malleoli for exsanguination of the limb followed by inflation of the pneumatic ankle tourniquet at the previously-mentioned time and pressures. 

Attention was then directed to the fifth digit of the right foot where two semi-elliptical incisions were made ellipsing a small teardrop shaped portion of skin. The incision was deepened via sharp and blunt dissection. All bleeding vessels were clamped and ligated and all vital structures were retracted medially and laterally. The proximal interphalangeal joint was then incised. The hood apparatus and extensor tendon were released and the lateral ligamentous structures were released allowing for the deliverance of the head of the proximal phalanx and the middle phalanx as well. The extensor tendon apparatus was then dissected to the level of the distal interphalangeal joint allowing for the removal of the middle phalanx. The middle phalanx was dissected of its tissue structures and removed. The lateral condyle head of the proximal phalanx was resected and smoothed with the use of a roto osteotome. The operative site was then lavaged with copious amounts of normal sterile saline and checked for evidence of bony prominence and none was noted. The deep structures were then coapted with the use of interrupted sutures of #3-0 Vicryl. The skin was then coapted with the use of interrupted sutures of #4-0 nylon. Sterile dressings consisted of Owen silk, 4 x 4 fluffs, Kling roll or bandage. The tourniquet was released in regard to the right foot. The color and temperature of the digits on the right foot were noted to return to normal. Capillary response was within three seconds of digits 1-5 on the right foot.

Attention was directed to the fifth digit of the left foot where, again, two semi-elliptical incisions were made to ellipse a small teardrop shape portion of the skin. The incision was deepened via sharp and blunt dissection. All bleeding vessels were clamped and ligated and all vital structures were retracted medially and laterally. The proximal interphalangeal joint was entered and the collateral ligamentous structures and extensor hood apparatus were released. The head of the proximal phalanx was delivered through the operative site, as was the middle phalanx as well. The extensor tendon apparatus was then dissected distally freeing it from the middle phalanx. The middle phalanx was then dissected of its soft tissue structures and removed from the operative site. The lateral condyle head of the proximal phalanx was then resected and smoothed with the use of a roto osteotome. The operative site was then lavaged with copious amounts of normal sterile saline and checked for further evidence of bony prominence and none was noted. The deep structures were then coapted with the use of interrupted sutures of #3-0 Vicryl. The skin was coapted with the use of interrupted sutures of #4-0 nylon. Sterile dressing consisted of Owen silk, 4 x 4 fluffs, Kling roll or bandage. The tourniquet was released and the color and temperature of the digits on the left foot were noted to return to normal. Capillary response was within three seconds of digits 1-5 of the left foot.

The patient tolerated the procedures well and left the operating room in apparent satisfactory condition. All sharps and sponges were accounted for. Minimal blood loss was noted.




*What is the first listed ICD-9-CM diagnosis code for this encounter?*
A. 735.5 
B. 735.8 
C. 735.4 
D. 755.66


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## rbeaver (Apr 25, 2009)

*Hammer toe dx code*

Would it not be c


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## mitchellde (Apr 26, 2009)

I am curious as to what the answer is in the practicum, because I agree the answer is C and really could be no other choice give this documentation.


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## blonde01 (Apr 26, 2009)

Since they do not give any other documentation on if this is acquired or congentital, I pretty sure that you should use 735.4(aquired).  I am curious of what the answer is as well.


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## Jamie Dezenzo (Apr 27, 2009)

I would also go w/ C


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## ckkohler (Apr 27, 2009)

*Answer is C*

The answer is C - I'm just studying for the ASC exam .. and nothing in the training guided me to either congenital or acquired ... is there a rule of thumb I should be aware of?  Thanks to all who answered!!!!


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## Anna Weaver (Apr 27, 2009)

*Opinions*

I just go by, if they do not specifically state congenital, I don't use it. If it's an infant under 28 days, I would use congenital. That's my opinion only. 
Anyone else?


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## magnolia1 (Apr 27, 2009)

For conditions (diagnoses) where "congenital" is listed as a choice in the 
ICD-9 book for that condition, I do not code it as congenital unless it is documented as such.


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