cclarson
Guru
Pt had a previous MPJ Arthrodesis that failed, the doctor decided to bring the pt in for a revisional surgery to correct it, converting the arthrodesis (28750) into a Keller Arthroplasty (28292). How would I code this? Normally a revision code is the same as the original, but since it was converted, do I only do the Keller cpt?
Here is the report:
POSTOPERATIVE DIAGNOSES:
1. Failed first metatarsophalangeal joint arthrodesis with residual hallux valgus deformity right foot.
2. Hardware pain first metatarsophalangeal joint right foot.
OPERATION PERFORMED:
Revisional surgery for failed first metatarsophalangeal joint arthrodesis with conversion to Keller arthroplasty first metatarsophalangeal joint and removal of previously implanted painful hardware, which in this case was a 26 mm compression screw.
DESCRIPTION OF PROCEDURE:
The patient was brought into the OR and placed supine on the table. General anesthesia was initiated. The right leg was prepped to the knee and draped in the usual sterile fashion. The tourniquet was inflated.
Attention was directed to the dorsomedial aspect of the first MPJ. A 5 cm dorsomedial incision was created through the skin. The incision was carried straight to bone where undermining was achieved, exposing the entire first MPJ the previously implanted compression screw was identified and removed and passed from the table. The proximal one third to one fourth of the proximal phalanx was resected with a sagittal saw. The bone was removed and passed from the table. The toe was then placed in the corrected position and fixated with a 0.062 smooth K-wire driven through the proximal and distal phalanges and retrograde to the base of the first metatarsal. Intraoperative x-rays validated satisfactory reduction deformity and satisfactory placement of the K-wire. The wound was flushed with copious amounts of sterile saline. Deep closure was achieved with 2-0 Vicryl. The subQ was closed with 3-0 Vicryl. The skin was closed with 4-0 nylon.
Thank you
Here is the report:
POSTOPERATIVE DIAGNOSES:
1. Failed first metatarsophalangeal joint arthrodesis with residual hallux valgus deformity right foot.
2. Hardware pain first metatarsophalangeal joint right foot.
OPERATION PERFORMED:
Revisional surgery for failed first metatarsophalangeal joint arthrodesis with conversion to Keller arthroplasty first metatarsophalangeal joint and removal of previously implanted painful hardware, which in this case was a 26 mm compression screw.
DESCRIPTION OF PROCEDURE:
The patient was brought into the OR and placed supine on the table. General anesthesia was initiated. The right leg was prepped to the knee and draped in the usual sterile fashion. The tourniquet was inflated.
Attention was directed to the dorsomedial aspect of the first MPJ. A 5 cm dorsomedial incision was created through the skin. The incision was carried straight to bone where undermining was achieved, exposing the entire first MPJ the previously implanted compression screw was identified and removed and passed from the table. The proximal one third to one fourth of the proximal phalanx was resected with a sagittal saw. The bone was removed and passed from the table. The toe was then placed in the corrected position and fixated with a 0.062 smooth K-wire driven through the proximal and distal phalanges and retrograde to the base of the first metatarsal. Intraoperative x-rays validated satisfactory reduction deformity and satisfactory placement of the K-wire. The wound was flushed with copious amounts of sterile saline. Deep closure was achieved with 2-0 Vicryl. The subQ was closed with 3-0 Vicryl. The skin was closed with 4-0 nylon.
Thank you