I am not good at coding podiatry but I try. I am really confused on this one. If, someone could please help me code this it would be greatly appreciated. He sent over CPT code 28299, but I kind of leaning toward 28289 & 28308.
Is this correct and if not why? So, that I will know next time when I have another one like this. Thanks in advance for your help!
POSTOPERATIVE DIAGNOSES: 1. Hallux abductovalgus, left foot.
2. Dorsal spur second metatarsal, left foot.
3. Tailor's bunion, left foot.
PROCEDURES PERFORMED: 1. Correction of hallux valgus.
2. Cheilectomy second metatarsal joint, left
foot.
3. Tailor's bunionectomy
The patient was identified and placed on the treatment table in the supine
position. Following general endotracheal intubation, the left foot was scrubbed, prepped and draped in
usual aseptic manner. Attention was directed to the first metatarsophalangeal joint of the left foot where a
linear incision was placed medial and parallel to the EHL tendon. Dissection was carried down on the
capsular attachment of the periosteal layer and joint. A linear periosteal incision was made exposing the
operative field to the joint. The dorsomedial eminence was resected with sagittal bone saw. An
osteotomy was completed in the medial aspect of the first metatarsal head. The apex pointing distally.
The arms put in proximal plantar and proximal dorsally. Capital fragment was distracted, moved more
lateral in the corrected anatomic alignment and impacted upon the first metatarsal shaft. 2x 2.5
cannulated bone screws were inserted from dorsal to plantar with excellent compression noted from
Medline with the screws. Irrigated with normal sterile saline. The remaining medial bone shelf was
resected without complication. The medial capsule was then closed with 2-0 Vicryl, subcutaneous tissue
with 3-0 Vicryl and skin closed with 4-0 nylon. Attention was directed to the second MTP where a linear
incision was placed on second interspace of the left foot. Blunt dissection was carried down to the
capsule where a linear periosteal incision was made lateral to the EDB. We reflected the dorsal
periosteum and extensor apparatus dorsally thus exposing the second met spurring to the operative field,
which was resected with a sagittal bone saw and rongeur. Irrigated with normal sterile saline. Closing the
capsular structures with 2-0 Vicryl, subcutaneous tissue with 3-0 Vicryl and skin closed with 4-0 nylon.
We moved to the procedure #3 over the left fifth metatarsal distally over the tailor's bunion where a linear
incision was made. Blunt dissection carried down to the capsule where a linear periosteal incision was
made. Periosteum was reflected medial and lateral exposing the joint operatively where a sagittal bone
saw was used to resect the lateral portion and dorsolateral portion of the fifth metatarsal head to reduce
bone prominence. Irrigated with normal sterile saline. Closing the periosteal layer with 2-0 Vicryl,
subcutaneous tissue with 3-0 Vicryl, skin closed with 4-0 nylon. Following completion of procedure, 50 cc
of Bupivacaine/Ketorolac infiltrated in the forefoot block. Adaptic, 4x4s, Kling and Ace bandages were
applied. The patient tolerated the procedure and was transferred out of the treatment room with vital
signs stable and vascular status intact.
Is this correct and if not why? So, that I will know next time when I have another one like this. Thanks in advance for your help!
POSTOPERATIVE DIAGNOSES: 1. Hallux abductovalgus, left foot.
2. Dorsal spur second metatarsal, left foot.
3. Tailor's bunion, left foot.
PROCEDURES PERFORMED: 1. Correction of hallux valgus.
2. Cheilectomy second metatarsal joint, left
foot.
3. Tailor's bunionectomy
The patient was identified and placed on the treatment table in the supine
position. Following general endotracheal intubation, the left foot was scrubbed, prepped and draped in
usual aseptic manner. Attention was directed to the first metatarsophalangeal joint of the left foot where a
linear incision was placed medial and parallel to the EHL tendon. Dissection was carried down on the
capsular attachment of the periosteal layer and joint. A linear periosteal incision was made exposing the
operative field to the joint. The dorsomedial eminence was resected with sagittal bone saw. An
osteotomy was completed in the medial aspect of the first metatarsal head. The apex pointing distally.
The arms put in proximal plantar and proximal dorsally. Capital fragment was distracted, moved more
lateral in the corrected anatomic alignment and impacted upon the first metatarsal shaft. 2x 2.5
cannulated bone screws were inserted from dorsal to plantar with excellent compression noted from
Medline with the screws. Irrigated with normal sterile saline. The remaining medial bone shelf was
resected without complication. The medial capsule was then closed with 2-0 Vicryl, subcutaneous tissue
with 3-0 Vicryl and skin closed with 4-0 nylon. Attention was directed to the second MTP where a linear
incision was placed on second interspace of the left foot. Blunt dissection was carried down to the
capsule where a linear periosteal incision was made lateral to the EDB. We reflected the dorsal
periosteum and extensor apparatus dorsally thus exposing the second met spurring to the operative field,
which was resected with a sagittal bone saw and rongeur. Irrigated with normal sterile saline. Closing the
capsular structures with 2-0 Vicryl, subcutaneous tissue with 3-0 Vicryl and skin closed with 4-0 nylon.
We moved to the procedure #3 over the left fifth metatarsal distally over the tailor's bunion where a linear
incision was made. Blunt dissection carried down to the capsule where a linear periosteal incision was
made. Periosteum was reflected medial and lateral exposing the joint operatively where a sagittal bone
saw was used to resect the lateral portion and dorsolateral portion of the fifth metatarsal head to reduce
bone prominence. Irrigated with normal sterile saline. Closing the periosteal layer with 2-0 Vicryl,
subcutaneous tissue with 3-0 Vicryl, skin closed with 4-0 nylon. Following completion of procedure, 50 cc
of Bupivacaine/Ketorolac infiltrated in the forefoot block. Adaptic, 4x4s, Kling and Ace bandages were
applied. The patient tolerated the procedure and was transferred out of the treatment room with vital
signs stable and vascular status intact.
