BFAITHFUL
Expert
I have info. from AAOS that states we can bill 28270 with 28285 because MTP is a separate/diff. joint from the PIP joint? but I'm still not sure if there are special circumstances for which I could bill both? & should i use MPT contractures as the diagnosis with it?
Attention first drawn to the dorsal aspect of the third toe, where two linear incisions were made encompassing the hyperkeratotic lesion. The length of these incisions was approximately 2.5cm. The incisions were connected and the wedge of skin was removed. The subcutaneous tissue was dissected medially and laterally exposing the extensor tendon. The tendon was transected as were the medial and lateral collateral ligaments. All soft tissues structures were dissected free from around the head of the proximal phalanx. With the use of a power oscilolating saw, a transverse osteotomy was created at the surgical neck of the hand. This was a thourgh and through osteotomy through all four cortices and had removed. The distal portion of the proximal phalanx was evaluated for any rough edges that were smooth.
The extensor tendon was now followed proximally and over the thrid metatarsophalangeal joint and an extensor hood release was performed. Following this lengthening, the toe was noted to sit in a better position, but still slightly elevated above the other toes. A capuslotomy was performed on the dorsal and medial sides. Following this, the toes were now noted sit flat within the same transverse plane as the other digits and in a straighter position.
Noting the position of the toe was now decided to close. rest of clolsure then was described.
Attention first drawn to the dorsal aspect of the third toe, where two linear incisions were made encompassing the hyperkeratotic lesion. The length of these incisions was approximately 2.5cm. The incisions were connected and the wedge of skin was removed. The subcutaneous tissue was dissected medially and laterally exposing the extensor tendon. The tendon was transected as were the medial and lateral collateral ligaments. All soft tissues structures were dissected free from around the head of the proximal phalanx. With the use of a power oscilolating saw, a transverse osteotomy was created at the surgical neck of the hand. This was a thourgh and through osteotomy through all four cortices and had removed. The distal portion of the proximal phalanx was evaluated for any rough edges that were smooth.
The extensor tendon was now followed proximally and over the thrid metatarsophalangeal joint and an extensor hood release was performed. Following this lengthening, the toe was noted to sit in a better position, but still slightly elevated above the other toes. A capuslotomy was performed on the dorsal and medial sides. Following this, the toes were now noted sit flat within the same transverse plane as the other digits and in a straighter position.
Noting the position of the toe was now decided to close. rest of clolsure then was described.