Wiki Arthrotomy with drilling of OCD talus (no grafting done)

[k4lilly]

Hi,

I cannot find a code for the open approach to micro drilling of the OCD of a talus without any grafting done. This seems odd to me because CPT assistant says "Clinical Example (28446) The patient has a symptomatic osteochondritis dissecans lesion of the talus, and the usual arthroscopic or open debridement and drilling have failed."

there was also no OATS done.

For those of you that prefer to have the op note:

Arthrotomy was performed at the ankle and the ankle joint was entered with the patient's foot held in dorsiflexion and inversion. The patient's osteochondral defect in the posterolateral aspect of the talus was identified. The unstable cartilaginous edges were removed with curved curet to stable borders, and then an angled pick was used to perform a microfracture procedure, essentially a drilling microfracture procedure of the osteochondral defect. Copious irrigation of the ankle joint was performed. The patient's remaining ankle cartilage appeared to be grossly normal on inspection with only some mild degenerative grade 1 articular cartilage changes to the remainder of the patient's ankle joint other than the osteochondral lesion.


What would you use for a CPT code? I have searched for hours

Thank you,
Kelly

 

[shecodes]

Seems like unlisted 28899 compared to 29891 would be worth considering.

I've ran across arguments for using 28100 as well.

It's somewhere to start..

 

[AlanPechacek]

Since Osteochondritis Dissecans is neither a bone cyst nor a benign tumor of the Talus, it would be a "stretch" to use 28100, even though it most accurately describes the procedure done (Debridement/Curettage of the lesion), but does not include the "Drilling" aspect. Since no autogenous or allograft was placed, then 28102 and 28103 could not be used either. Since this is not acute fracture treatment, no fracture codes for treatment of osteochondral talar fracture apply either. Since it was done "open" rather than "arthroscopically," the best code is probably be 28899, Unlisted Procedure, foot and toes, since the procedure was done on the Talus, which is a foot bone, with possibly Modifier 22 added (Increased Procedural Services, "Drilling/Microfracture"), and send the Operative Report for documentation.

Respectfully submitted, Alan Pechacek, M.D.