smh1312
New
Hi, I need some assistance with the following surgery. The provider performed a Left Lapidus bunionectomy w/ modified McBride procedure; 298297, LT 2nd MTPJ angular correction at the MTPJ and Weil osteotomy; 28308, LT 2nd extensor digitorum longus tendon lengthening; 28234, LT 2nd flexor digitorum longus tendon tenotomy and transfer to the dorsal 2nd toe; 28232, 27691/27690, or 28285. and LT 3rd, 4th, and 5th percutaneous flexor digitorum longus tenotomies at the level of the DIP joints; 28010x3.
I'm unsure which codes to bill for the 2nd metatarsal. Would I bill for the tenotomy 28232 or the fusion 28285?
Here's a description of the work for this location. Attention turned to the 2nd toe. Through the previous incision, I then bluntly dissected down to the extensor digitorum longus tendon and z-lengthened the tendon and exposed the dislocated 2nd MTP joint. Capsulotomy was performed. McGlamry elevator freed up the 2nd metatarsal head, and the 2nd metatarsal head was then shortened with sagittal saw osteotomy that then translated the 2nd metatarsal head proximally about 1cm. This was then held temporarily with k-wires. Overhanging bone was resected, and this exposed the plantar tissues. There was no plantar plate tissue remaining. This was a chronic dislocation. The only thing visible were the flexor tendons.
At this point, I then turned my attention tot he hammertoe correction. Through the same incision at the PIP joint, I r resected the PIP joint. I then accessed the flexor digitorum longus tendon through that joint, tenotomized it, and then retrieved it along the lateral aspect of the proximal phalanx and then brought it dorsally over the proximal phalanx to provide a tether that held the toe reduced because the plantar plate tissue was not able to be repaired. This was sutured to the dorsal extensor hood and localized tissue dorsally in the toe. following this, the metatarsal head was repositioned appropriately, and 2 Stryker 2.0mm cortical screws were then placed for fixation. The hammertoe was then held with two 0.45-inch K-wires that were driven across the PIP arthrodesis. I then drove both of those k-wires across the MTP joint as well to help with maintenance of the alignment of the toe while the soft tissues healed. K-wires were then cut and capped. The extensor tendon was then repaired with appropriate tensioning. The wound was then thorough irrigated. All incision were then closed in layers.
I'm unsure which codes to bill for the 2nd metatarsal. Would I bill for the tenotomy 28232 or the fusion 28285?
Here's a description of the work for this location. Attention turned to the 2nd toe. Through the previous incision, I then bluntly dissected down to the extensor digitorum longus tendon and z-lengthened the tendon and exposed the dislocated 2nd MTP joint. Capsulotomy was performed. McGlamry elevator freed up the 2nd metatarsal head, and the 2nd metatarsal head was then shortened with sagittal saw osteotomy that then translated the 2nd metatarsal head proximally about 1cm. This was then held temporarily with k-wires. Overhanging bone was resected, and this exposed the plantar tissues. There was no plantar plate tissue remaining. This was a chronic dislocation. The only thing visible were the flexor tendons.
At this point, I then turned my attention tot he hammertoe correction. Through the same incision at the PIP joint, I r resected the PIP joint. I then accessed the flexor digitorum longus tendon through that joint, tenotomized it, and then retrieved it along the lateral aspect of the proximal phalanx and then brought it dorsally over the proximal phalanx to provide a tether that held the toe reduced because the plantar plate tissue was not able to be repaired. This was sutured to the dorsal extensor hood and localized tissue dorsally in the toe. following this, the metatarsal head was repositioned appropriately, and 2 Stryker 2.0mm cortical screws were then placed for fixation. The hammertoe was then held with two 0.45-inch K-wires that were driven across the PIP arthrodesis. I then drove both of those k-wires across the MTP joint as well to help with maintenance of the alignment of the toe while the soft tissues healed. K-wires were then cut and capped. The extensor tendon was then repaired with appropriate tensioning. The wound was then thorough irrigated. All incision were then closed in layers.