kwinters
Contributor
First metatarsophalangeal joint capsular interposition arthroplasty
So my doctor performed the above listed procedure and I'm not able to find a code for this (except for the hand one 25447). I've looked @ 28289/28291 but he did an interposition graft and neither of those codes are quite right. I've attached the operative report in hopes that someone else has come across this scenerio before.
I would greatly appreciate some guidance with this.
Sincerely,
Kelly
OP NOTE:
A dorsal medial longitudinal incision was made just medial to the extensor hallucis longus tendon. The skin was incised and sharp dissection was carried down to the medial aspect of the extensor hallucis longus tendon. Care was taken to keep the tendon within its sheath.
Following this the extensor hallucis brevis teondon was identified and measured 4 cm proxima the first metatarsophalangeal joint. A full thickness dorsal capsulotomy brevis tendon was cut 4 cm away from the joint and sharply elevated off the bone. The extensor hallucis brevis tendon and capsule were then sharpley elevated up to the insertion into the proximal phalanx.
Following this bone spurs were removed from the first metatarsal head. The center of the proximal phalanx was drilled with a 0.062 K wire. The proximal phalanx was cut with a microsagittal saw in the subchondral region just proximal to the insertion of the extensor hallucis brevis tendon. The bone was removed. The metatarsal head was then smoothed and rounded to creat space for the INTERPOSITION GRAFT. The patient had unrestricted motion at this point so adequte bone resection had been achieved.
The wounds were then copiously irrigated. Two holes were drilled in the bas of the proximal phalanx with k wire both medially and laterally. Following this 2-0 fiberwire sutures were placed through the drill hole into the plantar plate flexor tissues deep. These were then saved i n an antegrade fashion through the proximal phalanx and out the tip of the distal phalanx.
The extensor hallucis brevis tendon INTERPOSITION tissue and capsular interposition tissue were then draped over the proximal phalanx and secured with sutures through the bone tunnels down to the base of the proximal phalanx. The graft was then flipped back on itself and the k wire was advanced in the oscillating fashion to capture the interposition graft. This was repeated two more times.
Following this vicryl sutures were used to stitch the graft together to make it into a ball form. I then drilled a k wire into the first metatarsal head, ensuring the toe was well alligned. The distance measured prior to cutting the proximal phalanx was measured again to ensure it was not shortened significantly. A k wire was then drilled from medial to lateral just past the first metatarsophalangeal joint to further enhance the rotational control.
Finally, the two fiberwire sutures that had been placed in the plantar plate and through the prximal phalanx were tied to secure the deep tissues to the proximal phalanx.
So my doctor performed the above listed procedure and I'm not able to find a code for this (except for the hand one 25447). I've looked @ 28289/28291 but he did an interposition graft and neither of those codes are quite right. I've attached the operative report in hopes that someone else has come across this scenerio before.
I would greatly appreciate some guidance with this.
Sincerely,
Kelly
OP NOTE:
A dorsal medial longitudinal incision was made just medial to the extensor hallucis longus tendon. The skin was incised and sharp dissection was carried down to the medial aspect of the extensor hallucis longus tendon. Care was taken to keep the tendon within its sheath.
Following this the extensor hallucis brevis teondon was identified and measured 4 cm proxima the first metatarsophalangeal joint. A full thickness dorsal capsulotomy brevis tendon was cut 4 cm away from the joint and sharply elevated off the bone. The extensor hallucis brevis tendon and capsule were then sharpley elevated up to the insertion into the proximal phalanx.
Following this bone spurs were removed from the first metatarsal head. The center of the proximal phalanx was drilled with a 0.062 K wire. The proximal phalanx was cut with a microsagittal saw in the subchondral region just proximal to the insertion of the extensor hallucis brevis tendon. The bone was removed. The metatarsal head was then smoothed and rounded to creat space for the INTERPOSITION GRAFT. The patient had unrestricted motion at this point so adequte bone resection had been achieved.
The wounds were then copiously irrigated. Two holes were drilled in the bas of the proximal phalanx with k wire both medially and laterally. Following this 2-0 fiberwire sutures were placed through the drill hole into the plantar plate flexor tissues deep. These were then saved i n an antegrade fashion through the proximal phalanx and out the tip of the distal phalanx.
The extensor hallucis brevis tendon INTERPOSITION tissue and capsular interposition tissue were then draped over the proximal phalanx and secured with sutures through the bone tunnels down to the base of the proximal phalanx. The graft was then flipped back on itself and the k wire was advanced in the oscillating fashion to capture the interposition graft. This was repeated two more times.
Following this vicryl sutures were used to stitch the graft together to make it into a ball form. I then drilled a k wire into the first metatarsal head, ensuring the toe was well alligned. The distance measured prior to cutting the proximal phalanx was measured again to ensure it was not shortened significantly. A k wire was then drilled from medial to lateral just past the first metatarsophalangeal joint to further enhance the rotational control.
Finally, the two fiberwire sutures that had been placed in the plantar plate and through the prximal phalanx were tied to secure the deep tissues to the proximal phalanx.
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