# Progenix putty ?



## codedog (Apr 19, 2011)

DOC did an excision and removal of osteochondroma/exostosis of great toe with removal of nail plate and a flap repair.   looking at cpt code 28108 , hope this is right , but  concerned about flap repair and the putty. Can I code those also. This is  an ASC  ?Thank you for your time .here is operative report in short 

OPERATIONS:  1.  Excision and removal of osteochondroma/exostosis of the left great toe.  2.  Total removal of nail plate of the left great toe.  3.  Flap and repair of the left great toe.



The patient was brought into the operating room.  It was decided to give a Mayo block consisting of 2% lidocaine plain and 0.5% Marcaine plain.  After this was done, we decided to put an ankle tourniquet in the left lower extremity and exsanguinated the left lower extremity.  After we exsanguinated the left lower extremity, we decided to prep and drape the foot in an aseptic manner.  Once this was done, we decided to address the area of the nail plate, in which we removed the nail plate in toto.  After removing the nail plate in toto, we decided with the use of a mallet and osteotome that we were going to resect the area of bone of the left great toe.  Under C-arm, we noted that the lesion definitely was no longer there.  The area was red.  It was copiously irrigated with saline.  We decided to ligate all bleeders in a sterile fashion.  We decided to make an incision down the proximal nailfold and opened up the proximal nailfold.  After opening up the proximal nailfold, we were able to put the Progenix putty into the area of the middle phalanx.  After putting the putty into the area of the middle phalanx, we decided to attempt plastic closure and a flap, for which we used 3-0 Prolene.  We were able to close the medial aspect onto the half of the nail bed.  Once this was done, we took another C-arm.  After taking another C-arm, we were able to note that the area was resected and removed.  Once this area was resected and removed, I gave an injection consisting of 1 cc of Decadron and 4 cc of 0.5% Marcaine plain.  Once this was done, we decided to close this area.  Once we closed this area, we were able to deflate the tourniquet.  After the tourniquet was deflated, the neurovascular status and capillary filling time was intact.  The patient tolerated the procedure and anesthesia well.  The patient was transferred from the operating room to Recovery.


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