Podiatry Coding & Billing Alert

Question: Please help with the diagnosis and procedural coding for the procedure mentioned below.

Post-operative diagnosis: Left foot first metatarsal extra ray polydactyly.

Operations performed: Left foot first metatarsal extra ray excision and osteotomy.

The operative note follows:

“The left leg was elevated and an Esmarch bandage was used to exsanguinate the foot, ankle, and lower leg region and used as a tourniquet above the ankle. Through the old incision between the first and second rays in the web space extending back toward the proximal end of the metatarsals, an incision was made and taken down through subcutaneous tissue. Dissection was continued down to the bone. X-ray was obtained. Bleeders were clamped and cauterized in the usual manner.

It was noted that the mass was very cartilaginous as well as being hard and actually bigger than what was suggested by the bony aspect of it that was on x-ray. A fluoroscopic examination was done where it was connecting to the first metatarsal. This was not in the joint area at the base of the first metatarsal right, but rather in the side of the metatarsal itself. Therefore, an osteotomy needed to be performed to remove this. This was done without difficulty.

It was to be noted though that on the lateral side of the first metatarsal, some of the cartilaginous on log was remaining and this was removed exposing some bone in this area, which was not exposed proximal and distal to it. The wound was irrigated out well. The tourniquet was taken down to try to determine if the bleeding was significant and it was not.”

Oregon Subscriber

Answer: This is only an excision of bone and not really an osteotomy per se. The osteotomy was done only to excise the bone and the tumor. You report code 28344 (Reconstruction, toe[s]; polydactyly) for this procedure.