In coding the attached I decided on codes 28296 TA, 28298 TA, 28291 TA. I am seeing these codes are considered inclusive to one another and was looking for someone to tell me if (per the op note) the use of 59 for each code is appropriate?
Since the work was performed on the MTP joint, the MT, and the proximal phalanx I am thinking that using the three codes for the three different areas would be appropriate with the 59 modifiers however, I just want to get someone else's take on it.
Thank you,
Cheryl
Postoperative Diagnosis:
1.Left symptomatic hallux valgus.
2.Left symptomatic hallux rigidus.
3.Left symptomatic hallux interphalangeus.
Procedure Performed:
1.Left chevron osteotomy.
2.Left distal soft tissue release.
3.Left dorsal cheilectomy.
4.Left Akin procedure.
Anesthesia: General with preoperative block.
IV Fluids: 700 mL crystalloid.
Tourniquet Time: 60 minutes.
Estimated Blood Loss: 5 mL.
Specimen: None.
Implants: Trim-It pin 2 x 100 mm by Arthrex x1, DynaNite staple 9 x 10 times 1 by Arthrex, FiberTak suture anchor 1.3 mm by Arthrex x1.
Indications: The patient is a 60-year-old female who has been having chronic pain in her left foot due to the above-mentioned deformity. After conservative treatment was attempted including shoe modification, she wanted surgery. I discussed the surgery in detail including risks such as neurovascular injury, blood loss, infection, wound complications, pain, DVT, malunion, nonunion, recurrence, hallux varus. She understood all the risks and is willing to proceed. All questions were answered.
Description of Procedure: The patient was transferred to the surgical suite where she was placed supine on a regular operative table. After the block was administered by the anesthesia team and anesthesia was administered as well, the left lower extremity was prepped and draped via sterile technique. A medial incision was made spanning the 1st metatarsophalangeal joint with a #15 blade. I incised the skin and subcutaneous tissue bluntly dissecting to expose the distal metatarsal head and the base of the 1st proximal phalanx of the great toe. I retracted the extensor hallucis longus and the flexor hallucis longus with Hohmann retractors to expose the whole metatarsal head. The first part of the case was dealing with the hallux rigidus. I was able to use a microsagittal saw to remove the dorsal spur in its entirety using a rongeur to smooth it down to smooth edge. After this hallux rigidus was performed, we then proceeded with the chevron osteotomy. Using a microsagittal saw, I removed a small eminence medially, after which I then created a chevron-type osteotomy using a microsagittal saw from medial to lateral. This was an inverted V with the apex of the osteotomy at the center of the metatarsal head. Once I completed the osteotomy, I shifted the capital fragment laterally nearly 7 to 8 mm and I placed 2 Trim-It pins 2 mm in width retrograde to hold reduction of the osteotomy. The pins themselves were flush to the surface of the joint. Once the pins were in, I removed the K-wire, which helped provisional fixation and it was stable. The remaining overhang was then removed as well with a microsagittal saw. Next, I then performed an osteotomy at the 1st proximal phalanx for the Akin procedure. The first was a parallel cut to the joint. The second one was an angle cut creating a wedge, which I removed. There was enough wedge removed to straighten out the hallux interphalangeus. Once the wedge was removed, I was able to then close the medial opening and held it down with a DynaNite staple. Finally, the distal soft tissue release; from the medial incision I was able to release the flexor brevis complex in the lateral aspect of the soft tissues with a Freer elevator. I then used a 1.3 FiberTak suture anchor to imbricate the medial capsule, which held the great toe in incongruent with the metatarsal. The sesamoids were also reduced. I then irrigated this wound with copious amount of saline after which the skin was closed with 3-0 Vicryl and 3-0 nylon. A sterile dressing was placed. The patient was then transferred to PACU.
Since the work was performed on the MTP joint, the MT, and the proximal phalanx I am thinking that using the three codes for the three different areas would be appropriate with the 59 modifiers however, I just want to get someone else's take on it.
Thank you,
Cheryl
Postoperative Diagnosis:
1.Left symptomatic hallux valgus.
2.Left symptomatic hallux rigidus.
3.Left symptomatic hallux interphalangeus.
Procedure Performed:
1.Left chevron osteotomy.
2.Left distal soft tissue release.
3.Left dorsal cheilectomy.
4.Left Akin procedure.
Anesthesia: General with preoperative block.
IV Fluids: 700 mL crystalloid.
Tourniquet Time: 60 minutes.
Estimated Blood Loss: 5 mL.
Specimen: None.
Implants: Trim-It pin 2 x 100 mm by Arthrex x1, DynaNite staple 9 x 10 times 1 by Arthrex, FiberTak suture anchor 1.3 mm by Arthrex x1.
Indications: The patient is a 60-year-old female who has been having chronic pain in her left foot due to the above-mentioned deformity. After conservative treatment was attempted including shoe modification, she wanted surgery. I discussed the surgery in detail including risks such as neurovascular injury, blood loss, infection, wound complications, pain, DVT, malunion, nonunion, recurrence, hallux varus. She understood all the risks and is willing to proceed. All questions were answered.
Description of Procedure: The patient was transferred to the surgical suite where she was placed supine on a regular operative table. After the block was administered by the anesthesia team and anesthesia was administered as well, the left lower extremity was prepped and draped via sterile technique. A medial incision was made spanning the 1st metatarsophalangeal joint with a #15 blade. I incised the skin and subcutaneous tissue bluntly dissecting to expose the distal metatarsal head and the base of the 1st proximal phalanx of the great toe. I retracted the extensor hallucis longus and the flexor hallucis longus with Hohmann retractors to expose the whole metatarsal head. The first part of the case was dealing with the hallux rigidus. I was able to use a microsagittal saw to remove the dorsal spur in its entirety using a rongeur to smooth it down to smooth edge. After this hallux rigidus was performed, we then proceeded with the chevron osteotomy. Using a microsagittal saw, I removed a small eminence medially, after which I then created a chevron-type osteotomy using a microsagittal saw from medial to lateral. This was an inverted V with the apex of the osteotomy at the center of the metatarsal head. Once I completed the osteotomy, I shifted the capital fragment laterally nearly 7 to 8 mm and I placed 2 Trim-It pins 2 mm in width retrograde to hold reduction of the osteotomy. The pins themselves were flush to the surface of the joint. Once the pins were in, I removed the K-wire, which helped provisional fixation and it was stable. The remaining overhang was then removed as well with a microsagittal saw. Next, I then performed an osteotomy at the 1st proximal phalanx for the Akin procedure. The first was a parallel cut to the joint. The second one was an angle cut creating a wedge, which I removed. There was enough wedge removed to straighten out the hallux interphalangeus. Once the wedge was removed, I was able to then close the medial opening and held it down with a DynaNite staple. Finally, the distal soft tissue release; from the medial incision I was able to release the flexor brevis complex in the lateral aspect of the soft tissues with a Freer elevator. I then used a 1.3 FiberTak suture anchor to imbricate the medial capsule, which held the great toe in incongruent with the metatarsal. The sesamoids were also reduced. I then irrigated this wound with copious amount of saline after which the skin was closed with 3-0 Vicryl and 3-0 nylon. A sterile dressing was placed. The patient was then transferred to PACU.