# Great toe problem



## Ksumansky (Nov 5, 2008)

I have a bugger of an OR Report that I am tring to figure out....I think I am now at the point where I am thinking way to far into it.  What do you think????

Attention was then directed to the medial aspect of the right first Metatarsophalangeal joint where an approximate 6 cm linear incision was placed.  The incision was deepened to the level of the joint capsule.  Dissection was carried into the lateral interspace where the abbuctor hallucis tendon and fibular sesamoid ligaments were identified, and sharply transected.  The extensor hallucis brevis tendon was identified and sharply transected as well.  A linear capsular incision was made and all capsular and ligamentous structures were sharply relfected from the medial aspect of the head of the first metatarsal.  Utilizing a power saw a through and through Chevron type osteotomy was fashioned in the head and neck of the first metatarsal.
Attention was then directed to the base of the hallux where and approximate 4 mm section of the proximal phalanx base was resected.  A #3 Vilex implant was inserted in the base of the proximal phalanx via appropriate technique.

So.....I am stuck between 28293 and 28296 or 28293 and 28306.......hmmmmm  Please Please help!  Any tip would help!  Thank you for all your time!


----------



## mbort (Nov 5, 2008)

you may want to consider 28292.  From what I have read, the Vilex is a hemi-implant, not total.

Also, the 28306 bundles with bunionectomy codes


----------



## Ksumansky (Nov 6, 2008)

What about 28296 only.........


----------



## magnolia1 (Nov 6, 2008)

I code 28293 for this procedure (and the Podiatrist who performs them told me that's what his office codes as well).


----------



## belindapearl (Nov 6, 2008)

I think I would use 28299.  Since 28293 is a total joint implant, does not fit.  28296 fits the osteotomy part but leaves out the hemi implant.  According to my Podiatry book 28299 extra coding tips states that it should be reported only when the hallux valgus correction cannot be reported with a more specific code or when combined methods are used


----------



## mbort (Nov 6, 2008)

I am sticking to the 28292.

I dont think this note qualifies for the 28296, nor I do think it qualifies for the 28293.

In 28293, ,the lay description states the surgeon "removes the joint".  I dont see this in the above documentation.

28296 does not include the hemi-implant.

Just my two cents.  
Mary


----------



## magnolia1 (Nov 6, 2008)

Refer to the description of 28293 in the attached website.

OP report above states "proximal phalanx was resected" which would qualify as "half joint".

Description of the CPT also indicates that the procedure includes all types of implants.


----------



## magnolia1 (Nov 6, 2008)

Oops.....here is the website.


http://www2.aaos.org/aaos/archives/bulletin/aug02/cod.htm


----------



## mbort (Nov 6, 2008)

magnolia1 said:


> Refer to the description of 28293 in the attached website.
> 
> OP report above states "proximal phalanx was resected" which would qualify as "half joint".
> 
> Description of the CPT also indicates that the procedure includes all types of implants.



Thanks, I actually have that printed out and refer to it often, which is what I did when I made "my suggestion".

28292 - ; Keller, McBride or Mayo type procedures These particular procedures involve a distal soft tissue release (McBride), *a resection of the base of the proximal phalanx (Keller),* or a resection of the metatarsal head (Mayo). AAOS states that this procedure includes: arthrotomy, synovial biopsy, tendon release or transfer, synovectomy, capsular release and reconstruction, removal of additional exostoses in the area of that joint, internal fixation, articular shaving, arthroscopy, removal of bursal tissue, repair of released tendon, capsular arthroplasty, first metatarsal head resection and excision of bone or synovial cysts and allows additional coding and report for: phalangeal osteotomy to correct deformity, proximal first metatarsal osteotomy and ankle tendon lengthening.


----------



## magnolia1 (Nov 6, 2008)

I understand, but I stand by 28293 because of the implant.

http://www.vilex.com/products/hemi_system.htm


----------



## mbort (Nov 6, 2008)

another great website...Isnt the Vilex a "hemi-implant"?

in 28292, in the CPT professional, page 122, it states "hemi implant optional".


----------

