Button Up This Tailor’s Bunion Procedure
Question: I need help coding the following operative report: “4 cm linear incision placed over fifth metatarsophalangeal joint (MPJ). Dissection carried down to level of joint capsule where a T capsulotomy was performed. All periosteal as well as capsular tissues were dissected free from the head of the fifth MPJ. Using a high-speed oscillated saw, the lateral eminence was removed. A tempered K-wire was inserted at the apex of the future osteotomy site. The osteotomy was then cut. The capital fragment was translocated medially about 1/3rd of the width of the metatarsal shaft. A 1.5 x 16 mm screw was placed across the osteotomy site going from the dorsal distal to the plantar proximal direction and tightened to two-finger tightness. The remaining lateral eminence was transected with high-speed saw. A 3-0 Vicryl was used to reapproximate the capsule, 4-0 subcutaneous, 5-0 for skin edges.” I have done extensive research and could not find a “reverse Austin bunionectomy” for fifth toe. Any help or explanation would be helpful. Georgia Subscriber Answer: It looks like a true osteotomy was performed on a tailor’s bunion, so you would look to code 28308 (Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each). If a complete resection of the fifth metatarsal head was performed, then 28113 (Ostectomy, complete excision; fifth metatarsal head) would be more appropriate; however, that is not what is documented in the operative report. Reverse Austin bunionectomy defined: A reverse Austin bunionectomy is a surgical intervention used to correct a hallux varus, a situation where the big toe leans inward toward the remaining toes; or a bunion deformity where the greater toe is slanted toward the other toes. This procedure is essentially the inverse of the typical Austin bunionectomy, which is utilized for hallux valgus, a condition where the big toe deviates outward. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
