ahodge90
Networker
Good morning!
I am needing some help with understanding the lapiplasty procedure and how it should truly be coded. I have a physician that believes that he should be coding the Lapiplasty as 28740 and 28270. It was always my understanding that this was coded as 28297. He is saying that this would be coded this way as long as he is not removing the medial eminence of the metatarsal head. I somewhat understand where he is coming from but wanted to get a little bit of clarification, if this thinking would indeed be correct, or if this would still not be appropriate.
Code description for the code 28297 per my coding tool..
The physician treats a bunion of the foot using any method in which the joint between the first metatarsal bone and medial cuneiform bone is fused (arthrodesis). The physician makes an incision in the skin between the first and second toes on the top of the foot. The incision is extended deep to the first metatarsophalangeal joint. The physician releases the contracted structures of the lateral joint. A second incision is made in the top of the foot over the medial metatarsocuneiform joint. The joint capsule is exposed and opened. The articular cartilage of the joint is removed. The ends of the bones are fashioned so they fit intimately together. The joint and bones of the big toe are manipulated into alignment. Fixation devices are needed to fuse the metatarsal and cuneiform bones. Prior to closing the incisions, the sesamoid bones are examined and removed as needed. The wounds are irrigated and closed in layers.
This is what the provider is stating.
The steps associated with the Lapiplasty® procedure include5 : 1. The plantar ligaments of the 1st metatarsocuneiform joint are released with an osteotome to allow for mobilization of the metatarsal. 2. Frontal, sagittal, and transverse plane adjustments are made to the first metatarsal to position the first metatarsal in corrected alignment. 3. A sagittal saw is used to remove the cartilage and small amount of subchondral bone from the base of the first metatarsal and the face of the medial cuneiform. 4. The 1st metatarsal and medial cuneiform bones are provisionally fixated in proper alignment and pre-compressed together using 2mm threaded olive wire(s) and/or straight k-wire(s). 5. A fixation plate is applied dorsally or dorsal-medially across the first tarsometatarsal joint with locking screws. 6. A second fixation plate may be applied across the medial surface of the first tarsometatarsal joint with locking screws.
The procedure detailed above describes rotation of the first metatarsal and arthrodesis of a single tarsometatarsal joint, the first metatarsocuneiform joint without resection of the medial eminence of the first metatarsal head. Therefore, the appropriate CPT® code for the procedure described above is: CPT® 28740 - Arthrodesis, midtarsal or tarsometatarsal, single joint.
Any guidance would be GREATLY appreciated!!
I am needing some help with understanding the lapiplasty procedure and how it should truly be coded. I have a physician that believes that he should be coding the Lapiplasty as 28740 and 28270. It was always my understanding that this was coded as 28297. He is saying that this would be coded this way as long as he is not removing the medial eminence of the metatarsal head. I somewhat understand where he is coming from but wanted to get a little bit of clarification, if this thinking would indeed be correct, or if this would still not be appropriate.
Code description for the code 28297 per my coding tool..
The physician treats a bunion of the foot using any method in which the joint between the first metatarsal bone and medial cuneiform bone is fused (arthrodesis). The physician makes an incision in the skin between the first and second toes on the top of the foot. The incision is extended deep to the first metatarsophalangeal joint. The physician releases the contracted structures of the lateral joint. A second incision is made in the top of the foot over the medial metatarsocuneiform joint. The joint capsule is exposed and opened. The articular cartilage of the joint is removed. The ends of the bones are fashioned so they fit intimately together. The joint and bones of the big toe are manipulated into alignment. Fixation devices are needed to fuse the metatarsal and cuneiform bones. Prior to closing the incisions, the sesamoid bones are examined and removed as needed. The wounds are irrigated and closed in layers.
This is what the provider is stating.
The steps associated with the Lapiplasty® procedure include5 : 1. The plantar ligaments of the 1st metatarsocuneiform joint are released with an osteotome to allow for mobilization of the metatarsal. 2. Frontal, sagittal, and transverse plane adjustments are made to the first metatarsal to position the first metatarsal in corrected alignment. 3. A sagittal saw is used to remove the cartilage and small amount of subchondral bone from the base of the first metatarsal and the face of the medial cuneiform. 4. The 1st metatarsal and medial cuneiform bones are provisionally fixated in proper alignment and pre-compressed together using 2mm threaded olive wire(s) and/or straight k-wire(s). 5. A fixation plate is applied dorsally or dorsal-medially across the first tarsometatarsal joint with locking screws. 6. A second fixation plate may be applied across the medial surface of the first tarsometatarsal joint with locking screws.
The procedure detailed above describes rotation of the first metatarsal and arthrodesis of a single tarsometatarsal joint, the first metatarsocuneiform joint without resection of the medial eminence of the first metatarsal head. Therefore, the appropriate CPT® code for the procedure described above is: CPT® 28740 - Arthrodesis, midtarsal or tarsometatarsal, single joint.
Any guidance would be GREATLY appreciated!!
