I need help coding this please! I am not real good with coding feet and if I could get some direction it would be greatly appreciated. I have 28755- T5, 28285 - T6, T7, T7, T9. The doctor has coded it as 28270 - T5-T9 and 28285 T5- T9. I am completely lost.
POSTOPERATIVE DIAGNOSES: 1. Right hallux interphalangeal joint arthritis
with dorsal contracture.
2. Right #1 through #5 metatarsal phalangeal
joint dorsal dislocations.
3. Right #2 through #5 claw toe deformities
PROCEDURES PERFORMED:
1. Right hallux interphalangeal joint arthrodesis.
2. Right #1 through #5 metatarsal phalangeal
joint open reduction with pinning.
3. Right #2 through #5 claw toe corrections
The patient's right lower extremity was marked prior to consent was
obtained and transferred to the operating room, and placed in supine position on the operating table,
sedated per Anesthesia. The patient underwent an ankle block. Right foot was prepped and draped in
sterile fashion. Time-out was taken for proper identity, extremity, procedure confirmed. Tourniquet was
inflated to 300 mmHg. A dorsal longitudinal incision was extended to the hallux #2, 3, 4, and 5 toes at the
level of PIP and DIP joints at hallux second and four toes. Incision was extended over the forefoot at the
level of the MTP joints. Dissection was carried to the dorsal aspect of the MTP joint of the #1 through #5
toes, there was noted to be dorsal dislocation at each joint. A dorsal capsulotomy was created and
McGlamry elevators were placed through the plantar aspect of the joint release plantar contracted tissues.
This allowed for reduction of the joints on the second through fifth metatarsals, there was dorsal
osteophyte that had formed over the dorsal joint at the side of dislocation that was removed at each one of
the rongeur. Once this was complete, the IP joint was exposed at the hallux due to the severe
contracture, it was noted there was severe arthrosis to the joint. The head of the proximal phalanx was
resected with the sagittal saw. Residual cartilage was removed from base of the distal phalanx with a
rongeur. K-wire was then drilled retrograde through distal phalanx into the proximal phalanx correcting
the toe deformity. Following this, the head of the proximal phalanx was resected with sagittal saw with
the #2, 3, 4, and 5 toes. The cartilage removed from the base of middle phalanx with rongeur. The
cartilage was removed at the DIP joint for the rongeur. 0.062 inch K-wire was then drilled retrograde
through the distal phalanx, middle phalanx into the proximal phalanx claw toe deformities in the number 2
through 5 toes. Each toe was then held in plantarflexed position while the pins were passed across the
MTP joints, stabilizing the MTP joint reductions. Fluoroscopy was confirmed appropriate placement of all
pins. Pins were then bent and clipped at the distal end of the toes. Incision sites were then thoroughly
irrigated and closures undertaken in layer fashion with 3-0 Monocryl sutures followed by 4-0 nylon suture
and skin. Incision site were then covered with Xeroform dressing, 4x4 gauze, cast padding, and elastic
bandage.
POSTOPERATIVE DIAGNOSES: 1. Right hallux interphalangeal joint arthritis
with dorsal contracture.
2. Right #1 through #5 metatarsal phalangeal
joint dorsal dislocations.
3. Right #2 through #5 claw toe deformities
PROCEDURES PERFORMED:
1. Right hallux interphalangeal joint arthrodesis.
2. Right #1 through #5 metatarsal phalangeal
joint open reduction with pinning.
3. Right #2 through #5 claw toe corrections
The patient's right lower extremity was marked prior to consent was
obtained and transferred to the operating room, and placed in supine position on the operating table,
sedated per Anesthesia. The patient underwent an ankle block. Right foot was prepped and draped in
sterile fashion. Time-out was taken for proper identity, extremity, procedure confirmed. Tourniquet was
inflated to 300 mmHg. A dorsal longitudinal incision was extended to the hallux #2, 3, 4, and 5 toes at the
level of PIP and DIP joints at hallux second and four toes. Incision was extended over the forefoot at the
level of the MTP joints. Dissection was carried to the dorsal aspect of the MTP joint of the #1 through #5
toes, there was noted to be dorsal dislocation at each joint. A dorsal capsulotomy was created and
McGlamry elevators were placed through the plantar aspect of the joint release plantar contracted tissues.
This allowed for reduction of the joints on the second through fifth metatarsals, there was dorsal
osteophyte that had formed over the dorsal joint at the side of dislocation that was removed at each one of
the rongeur. Once this was complete, the IP joint was exposed at the hallux due to the severe
contracture, it was noted there was severe arthrosis to the joint. The head of the proximal phalanx was
resected with the sagittal saw. Residual cartilage was removed from base of the distal phalanx with a
rongeur. K-wire was then drilled retrograde through distal phalanx into the proximal phalanx correcting
the toe deformity. Following this, the head of the proximal phalanx was resected with sagittal saw with
the #2, 3, 4, and 5 toes. The cartilage removed from the base of middle phalanx with rongeur. The
cartilage was removed at the DIP joint for the rongeur. 0.062 inch K-wire was then drilled retrograde
through the distal phalanx, middle phalanx into the proximal phalanx claw toe deformities in the number 2
through 5 toes. Each toe was then held in plantarflexed position while the pins were passed across the
MTP joints, stabilizing the MTP joint reductions. Fluoroscopy was confirmed appropriate placement of all
pins. Pins were then bent and clipped at the distal end of the toes. Incision sites were then thoroughly
irrigated and closures undertaken in layer fashion with 3-0 Monocryl sutures followed by 4-0 nylon suture
and skin. Incision site were then covered with Xeroform dressing, 4x4 gauze, cast padding, and elastic
bandage.