pwebbabshire@cox.net
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Anyone in ortho that is experienced in the foot area, please chime in.
1. Application of Stress for Joint Radiography of Left Foot 77071
2. Left Fourth Hammertoe Repair 28285-T3
3. Left Fourth Superficial Transfer of Extensor Hallucis Brevis to Longus 27691-LT ( this one does not bundle but I am wondering if I should code it since tendon transfer is part of 28285)
4. Left Correction of Angular Deformity of Metatarsophalangeal Joint with Soft Tissue Repair, Fourth Toes- Omit bundled
5. Left Deep Implant Removal, Staple, Great Toe Phalanx
6. Left Deep Implant, 3rd Toe Screw Removal
7. Left Partial Excision of Bone, 1st Metatarsal 28122-LT
8. Left Partial Excision of Bone, Great Toe Proximal Phalanx 28124XS-TA (xs to show that bone is taken from sep. site of 28285)
9. Left Partial Excision of Bone, Third Toe Distal Phalanx 28124-XS-T2 (xs to show that bone is taken from sep. site of 28285)
The operative extremity was exsanguinated followed by inflation of the tourniquet to 250mmHg. At this point, attention was
placed to the toe deformities of the fourth toes. A longitudinal incision was created over the toe extending through skin and
subcutaneous tissue down to the extensor tendons. The EDL and EDB tendons were separate and they were incised for future
superficial transfer to help correct the deformity. Then using a small saw blade, the distal condyle of the proximal phalanx was
excised and then using a rongeur, a small amount of bone was removed off of the proximal aspect of the middle phalanx. Then
a double ended k-wire was advanced distally through the end of the toe and then retrograde placed into the proximal phalanx
when held in a corrected position. The pin was then advanced across the MTP joint to stabilize the deformity and using a Vicryl
suture a soft tissue repair was obtained to correct the angular deformity at the capsule and lateral and medial ligaments. Lastly,
the distal aspect of the of the EDB tendon was transferred to the proximal aspect of the EDL tendon superficially to allow the
stronger flexors to balance out the weaker intrinsics. The area was irrigated and then the incision was closed with 3-0 Monocryl
suture and 3-0 Nylon for the skin.
An incision was created on the medial side of the 1st MTP joint and scar tissue was removed from this area. The capsule was
elevated for later repair and imbrication. An incision was created over the proximal phalanx overlying the staple and an elevator
was placed under the staple and this deep implant was removed without complication. The bony osteophyte overlying the
phalanx was smoothed down and a partial excision of bone of the great toe proximal phalanx was performed. Then using a
power rasp, a partial excision of bone was performed of the 1st metatarsal to remove bossing on the medial side of the 1st
Metatarsal down to a smooth surface. The area was irrigated with normal saline and then using a 2-0 Vicryl suture, the medial
capsule was imbricated with the toe held in a reduced anatomic position. This incision was irrigated followed by closure with 3-0
Monocryl and 3-0 Nylon suture.
An incision was created at the distal tip of the third toe and a partial excision of bone was performed of the osteophyte overlying
this area. Then a guidepin for the cannulated screw was placed through the screw. It was attempted to take the screw out but
the screw head was stripped. A screw removal set had to be utilized in order to trefon around the screw and remove the screw
manually. This area was irrigated followed by 3-0 Nylon suture
1. Application of Stress for Joint Radiography of Left Foot 77071
2. Left Fourth Hammertoe Repair 28285-T3
3. Left Fourth Superficial Transfer of Extensor Hallucis Brevis to Longus 27691-LT ( this one does not bundle but I am wondering if I should code it since tendon transfer is part of 28285)
4. Left Correction of Angular Deformity of Metatarsophalangeal Joint with Soft Tissue Repair, Fourth Toes- Omit bundled
5. Left Deep Implant Removal, Staple, Great Toe Phalanx
6. Left Deep Implant, 3rd Toe Screw Removal
7. Left Partial Excision of Bone, 1st Metatarsal 28122-LT
8. Left Partial Excision of Bone, Great Toe Proximal Phalanx 28124XS-TA (xs to show that bone is taken from sep. site of 28285)
9. Left Partial Excision of Bone, Third Toe Distal Phalanx 28124-XS-T2 (xs to show that bone is taken from sep. site of 28285)
The operative extremity was exsanguinated followed by inflation of the tourniquet to 250mmHg. At this point, attention was
placed to the toe deformities of the fourth toes. A longitudinal incision was created over the toe extending through skin and
subcutaneous tissue down to the extensor tendons. The EDL and EDB tendons were separate and they were incised for future
superficial transfer to help correct the deformity. Then using a small saw blade, the distal condyle of the proximal phalanx was
excised and then using a rongeur, a small amount of bone was removed off of the proximal aspect of the middle phalanx. Then
a double ended k-wire was advanced distally through the end of the toe and then retrograde placed into the proximal phalanx
when held in a corrected position. The pin was then advanced across the MTP joint to stabilize the deformity and using a Vicryl
suture a soft tissue repair was obtained to correct the angular deformity at the capsule and lateral and medial ligaments. Lastly,
the distal aspect of the of the EDB tendon was transferred to the proximal aspect of the EDL tendon superficially to allow the
stronger flexors to balance out the weaker intrinsics. The area was irrigated and then the incision was closed with 3-0 Monocryl
suture and 3-0 Nylon for the skin.
An incision was created on the medial side of the 1st MTP joint and scar tissue was removed from this area. The capsule was
elevated for later repair and imbrication. An incision was created over the proximal phalanx overlying the staple and an elevator
was placed under the staple and this deep implant was removed without complication. The bony osteophyte overlying the
phalanx was smoothed down and a partial excision of bone of the great toe proximal phalanx was performed. Then using a
power rasp, a partial excision of bone was performed of the 1st metatarsal to remove bossing on the medial side of the 1st
Metatarsal down to a smooth surface. The area was irrigated with normal saline and then using a 2-0 Vicryl suture, the medial
capsule was imbricated with the toe held in a reduced anatomic position. This incision was irrigated followed by closure with 3-0
Monocryl and 3-0 Nylon suture.
An incision was created at the distal tip of the third toe and a partial excision of bone was performed of the osteophyte overlying
this area. Then a guidepin for the cannulated screw was placed through the screw. It was attempted to take the screw out but
the screw head was stripped. A screw removal set had to be utilized in order to trefon around the screw and remove the screw
manually. This area was irrigated followed by 3-0 Nylon suture