# OCD Talus



## sdomel159 (Feb 20, 2013)

Help!  We have two foot and ankle specialists that at times repair an OCD of the talus.
They are stating that since the graft utilized is not an "osteochondral graft" the procedure is not an OATS (28446).  I will post the operative report as soon as it is completed but wanted to know if anyone else has this same struggle with their physicians? So if we are not billing the 28446 due to the type of graft what would the appropriate code(s) be?

Any feedback is appreciated.

Here is the operative report:

Medial malleolar osteotomy 

Debridement of osteochondral lesion 

Harvesting of autogenous graft from the ipsilateral calcaneus 

Bone grafting to the osteochondral lesion 



PREOPERATIVE DIAGNOSIS:  

Osteochondral lesion, medial talar dome 



POSTOPERATIVE DIAGNOSIS:   

Osteochondral lesion, medial talar dome 


DESCRIPTION OF SURGERY:  Patient was taken to the operating room and placed supine on the operating table where a laryngeal mask anesthetic was induced. The left lower extremity was prepped and draped in sterile fashion. Pneumatic tourniquet was raised after the extremity was exsanguinated. A longitudinal incision was made over the medial malleolus. Dissection was carried through subcutaneous tissue sharply. Full thickness cutaneous flaps were lifted. The medial malleolus was predrilled with 2.5 drill bits preparing two screw holes crossing the proposed osteotomy. I then created a chevron osteotomy in the medial malleolus starting above the level of the joint and going down to the corner of the medial ankle joint. The medial malleolar fragment was retracted distally exposing the medial talar dome. Clear delineation of the osteochondral lesion was noted. This was debrided back to healthy appearing bone with a curette. All cartilage that was not particularly well attached was removed with a curette and/or small rongeur. There was a defect in the bone subsequent to removal and in fact a thin sliver of bone attached to the chondral lesion. I then made a stab wound over his medial calcaneus. I used a 3.5 drill guide to harvest a couple of plugs of cancellous bone. This was morselized and packed into the defect to the level of the subchondral bone in his talus. I then placed a fiber and glue patch over the bone graft to keep things in place while it healed. Wounds were irrigated copiously with normal saline. Two screws were placed across the medial malleolar osteotomy. Final pictures were obtained. Subcutaneous tissues and skin were closed in layers. A sterile dressing was applied followed by a postop boot. Patient was awakened and taken to the recovery room in stable condition. 




i love coding,i love coding, i love coding  *sigh*

Thanks,
Sharon


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