CCANTER
Networker
1. Any resources for podiatry surgical coding? i cant find any?
2. A provider performed a total ankle arthroplasty CPT code 27702 with a talectomy CPT code 28130
I know these 2 cpt codes do bundle. And as i read the description for a total ankle arthroplasty it does include this "A cutting guide is then placed over the talus and a portion of the talus is excised."
would i be able to charge it out if a total talectomy was done?
pREOPERATIVE DIAGNOSES
1. Left ankle contracture
2. Left ankle traumatic arthritis.
3. Left ankle deformity
4. Left ankle pain
5. Hindfoot varus
6. Cavus
POSTOPERATIVE DIAGNOSES
1. Left ankle contracture
2. Left ankle traumatic arthritis.
3. Left ankle deformity
4. Left ankle pain
5. Hindfoot varus
6. Cavus
An anterior incision was made overlying the ankle and taken down with careful dissection. All neurovascular structures were ligated, retracted, or cauterized as needed. Longitudinal capsulotomy was made and the soft tissues were reflected off the distal tibia and talus. The talus was freed of soft tissue attachment and removed in total.
Restore jig applied and foot pinned down. The jig was checked and set in AP/LAteral views. The tibial cut was sized and checked on fluoroscopy multiple times. This was resected and removed in total. This had a nice stable appearance.
Tibial broach was performed through the incision. We placed a kinos implant .
The total talus was placed in the area noted of good position. This was locked down with a 6. 5 screws from Ortho solutions. Stressing of the ankle was done and there was significant varus tilt. Subtalar joint fusion performed with Ortho solution screws of locking down the total talus.
Polywas inserted and noted have good placement within the area. Noted rectus movement of the ankle.Talus was sized and tibial tray fixated. Poly trialed and size 6 inserted.
3 percutaneous incisions are made overlying the distal achilles. The ankle was dorsiflexed and noted increase of at least 5 degrees past rectus. No instability noted. Closed with 3-0 nylon in simple technique.
There is significant bone with avulsion type fractures at the distal end of the medial malleolus. This was removed with sharp dissection. Due to the significant laxity of the deltoid ligament this was repaired by running a FiberWire drill tunnel through the medial malleolus. The FiberWire was passed through the area and tied down to lock up the deltoid in this area. An additional push lock was used to pull the anterior portion of the deltoid up into the area as well. This was drilled and surgical manufacture specifications. Upon stressing noted no significant instability of the deltoid ligament.
Incision was made over the first metatarsal this was taken down to the base of the metatarsal. Periosteal incision was made and a periosteal flap was raised. A sagittal saw was used to make a dorsally based wedge approximately a 4 mm wedge was removed. This was feathered down with a sagittal saw and noted have good compression this was fixated with 1 Ortho solution screw. Appropriately drilled and the screw were applied and noted to have good compression. This balanced the forefoot pressures and significantly dorsiflex the first ray.
Postoperative fluoroscopy showed a rectus ankle with tibiotalar overlap. Good compression of implants/bony interface Was noted.
2. A provider performed a total ankle arthroplasty CPT code 27702 with a talectomy CPT code 28130
I know these 2 cpt codes do bundle. And as i read the description for a total ankle arthroplasty it does include this "A cutting guide is then placed over the talus and a portion of the talus is excised."
would i be able to charge it out if a total talectomy was done?
pREOPERATIVE DIAGNOSES
1. Left ankle contracture
2. Left ankle traumatic arthritis.
3. Left ankle deformity
4. Left ankle pain
5. Hindfoot varus
6. Cavus
POSTOPERATIVE DIAGNOSES
1. Left ankle contracture
2. Left ankle traumatic arthritis.
3. Left ankle deformity
4. Left ankle pain
5. Hindfoot varus
6. Cavus
An anterior incision was made overlying the ankle and taken down with careful dissection. All neurovascular structures were ligated, retracted, or cauterized as needed. Longitudinal capsulotomy was made and the soft tissues were reflected off the distal tibia and talus. The talus was freed of soft tissue attachment and removed in total.
Restore jig applied and foot pinned down. The jig was checked and set in AP/LAteral views. The tibial cut was sized and checked on fluoroscopy multiple times. This was resected and removed in total. This had a nice stable appearance.
Tibial broach was performed through the incision. We placed a kinos implant .
The total talus was placed in the area noted of good position. This was locked down with a 6. 5 screws from Ortho solutions. Stressing of the ankle was done and there was significant varus tilt. Subtalar joint fusion performed with Ortho solution screws of locking down the total talus.
Polywas inserted and noted have good placement within the area. Noted rectus movement of the ankle.Talus was sized and tibial tray fixated. Poly trialed and size 6 inserted.
3 percutaneous incisions are made overlying the distal achilles. The ankle was dorsiflexed and noted increase of at least 5 degrees past rectus. No instability noted. Closed with 3-0 nylon in simple technique.
There is significant bone with avulsion type fractures at the distal end of the medial malleolus. This was removed with sharp dissection. Due to the significant laxity of the deltoid ligament this was repaired by running a FiberWire drill tunnel through the medial malleolus. The FiberWire was passed through the area and tied down to lock up the deltoid in this area. An additional push lock was used to pull the anterior portion of the deltoid up into the area as well. This was drilled and surgical manufacture specifications. Upon stressing noted no significant instability of the deltoid ligament.
Incision was made over the first metatarsal this was taken down to the base of the metatarsal. Periosteal incision was made and a periosteal flap was raised. A sagittal saw was used to make a dorsally based wedge approximately a 4 mm wedge was removed. This was feathered down with a sagittal saw and noted have good compression this was fixated with 1 Ortho solution screw. Appropriately drilled and the screw were applied and noted to have good compression. This balanced the forefoot pressures and significantly dorsiflex the first ray.
Postoperative fluoroscopy showed a rectus ankle with tibiotalar overlap. Good compression of implants/bony interface Was noted.