pJohnson15
Networker
This procedure was done with an Austin bunionectomy. For the bunionectomy, I am thinking 28296-LT, but I am also wondering if the osteotomy could be coded separately. I can't find anything for the arthroplasty, so I'm thinking it would be the unlisted code, 28899, and the MPJ release and pinning has me stumped. Here is a redacted procedure note. Any help on this would be greatly appreciated!
Attention was directed to the left foot where a dorsomedial curvilinear incision was placed over the first metatarsophalangeal joint. The incision was carried through skin and subcutaneous tissues. Care was taken to avoid all neurovascular structures and all bleeders were cauterized as necessary. A longitudinal capsulotomy was then performed and the capsular tissues were elevated off the medial aspect of the first metatarsal head. Using a sagittal saw, the medial eminence was resected. Using a K-wire as an access guide, a Chevron osteotomy was placed in the head of the first metatarsal. The capital fragment was translated laterally. A modified Stein interspace release was performed just prior to osteotomy. The osteotomy was then temporarily fixed with a K-wire from the OsteoMed set and a 3.0 x 18mm screw was placed across the fracture fragment in standard fashion and directed from distal dorsal to plantar proximal. The screw was felt to hold well. The remaining medial eminence was then resected with sagittal saw. Vigorous lavage was performed. Capsular tissues were closed with 2-0 Vicry. Subcu was closed with 4-0 Monocryl. Skin was closed with 5-0 Prolene.
Attention was then directed to the second digit where a dorsal incision was placed from PIPJ to MPJ. The incision was placed through skin and subcutaneous tissues. Care was taken to avoid all neurovascular structures and all bleeders were cauterized as necessary. A transverse tenotomy and capsulotomy was performed at the PIPJ and the tissues were elevated off the head of the proximal phalanx. Using sagittal saw, the head of the proximal phalanx was then resected.
Attention was then directed to the MPJ where a standard release was performed including tenotomy, capsulotomy, collateral ligament release and plantar plate release, using a K-wire for additional stability. Following vigorous lavage, the K-wire was place through the middle and distal phalanges and retrograded back through proximal phalanx and into the metatarsal head. The digit was felt to be in excellent position and capsular tissues were then closed with 4-0 Monocryl. Subcutaneous tissues were then closed with 4-0 Moncryl and skin was closed with 5-0 Prolene. The pin was bent, cut and capped and antibiotic ointment was placed at the pin site.
Attention was directed to the left foot where a dorsomedial curvilinear incision was placed over the first metatarsophalangeal joint. The incision was carried through skin and subcutaneous tissues. Care was taken to avoid all neurovascular structures and all bleeders were cauterized as necessary. A longitudinal capsulotomy was then performed and the capsular tissues were elevated off the medial aspect of the first metatarsal head. Using a sagittal saw, the medial eminence was resected. Using a K-wire as an access guide, a Chevron osteotomy was placed in the head of the first metatarsal. The capital fragment was translated laterally. A modified Stein interspace release was performed just prior to osteotomy. The osteotomy was then temporarily fixed with a K-wire from the OsteoMed set and a 3.0 x 18mm screw was placed across the fracture fragment in standard fashion and directed from distal dorsal to plantar proximal. The screw was felt to hold well. The remaining medial eminence was then resected with sagittal saw. Vigorous lavage was performed. Capsular tissues were closed with 2-0 Vicry. Subcu was closed with 4-0 Monocryl. Skin was closed with 5-0 Prolene.
Attention was then directed to the second digit where a dorsal incision was placed from PIPJ to MPJ. The incision was placed through skin and subcutaneous tissues. Care was taken to avoid all neurovascular structures and all bleeders were cauterized as necessary. A transverse tenotomy and capsulotomy was performed at the PIPJ and the tissues were elevated off the head of the proximal phalanx. Using sagittal saw, the head of the proximal phalanx was then resected.
Attention was then directed to the MPJ where a standard release was performed including tenotomy, capsulotomy, collateral ligament release and plantar plate release, using a K-wire for additional stability. Following vigorous lavage, the K-wire was place through the middle and distal phalanges and retrograded back through proximal phalanx and into the metatarsal head. The digit was felt to be in excellent position and capsular tissues were then closed with 4-0 Monocryl. Subcutaneous tissues were then closed with 4-0 Moncryl and skin was closed with 5-0 Prolene. The pin was bent, cut and capped and antibiotic ointment was placed at the pin site.