Halvorsenjt
New
Hi all!
I have a provider that is insistent on billing 28313 for plantar plate repair for rupture with 28308 for the osteotomy on the associated metatarsal. I'm not showing bundling edits through NCCI, however, the description of 28308 includes the angular correction, lengthening or shortening in addition to the osteotomy. Would the angular correction apply to the phalanx or is that only applying to the metatarsal angle? Is it appropriate to bill 28313?
"A curvilinear incision was made directly over the 3rd MTP joint. I incised through skin and subcutaneous tissue, bluntly dissected to the medial aspect of the extensor tendons, and performed a capsulotomy into the 3rd MTP joint. McGlamry elevator was utilized to free up the capsular connections. I then inspected the plantar plate and found a partial tear along the lateral aspect. I completed the plantar plate disruption and drilled 2 vertical tunnels into the base of the proximal phalanx of the 3rd toe. I then performed a Weil osteotomy and retracted the 3rd metatarsal head proximally and held it temporarily. I then accessed the plantar plate and placed 2 #2 FiberWires into the plantar plate. The tissue was healthy appearing. It had been released from the base of the proximal phalanx of the 3rd toe. Using a Smith and Nephew mini FirstPass, I then brought both sutures through the plantar plate. I then brought those sutures, 1 medial and 1 lateral, through the bone tunnels of the proximal phalanx. I then released the temporary fixation on the metatarsal and let it drift distally. I then tensioned the plantar plate appropriately, tied it down over the top of the proximal phalanx with the FiberWire, tying each strand to the other. I then brought the metatarsal head distally and translated it medially as well. This reduced the 3rd toe nicely. It had previously been in varus and was now well balanced and well aligned. I see I then utilized 2 Stryker 2.0 mm cortical screws for fixation of the metatarsal osteotomy and removed overhanging bone. There was a slight shortening ultimately of the metatarsal by about 2 to 3 mm. This then completed the construct. I was able to range the 3rd toe nicely. The shortening of the metatarsal functionally lengthened the extensor tendons just slightly, and I then shortened them with 2-0 Vicryl."
I'd really love some guidance as this has been an ongoing question in my group.
I have a provider that is insistent on billing 28313 for plantar plate repair for rupture with 28308 for the osteotomy on the associated metatarsal. I'm not showing bundling edits through NCCI, however, the description of 28308 includes the angular correction, lengthening or shortening in addition to the osteotomy. Would the angular correction apply to the phalanx or is that only applying to the metatarsal angle? Is it appropriate to bill 28313?
"A curvilinear incision was made directly over the 3rd MTP joint. I incised through skin and subcutaneous tissue, bluntly dissected to the medial aspect of the extensor tendons, and performed a capsulotomy into the 3rd MTP joint. McGlamry elevator was utilized to free up the capsular connections. I then inspected the plantar plate and found a partial tear along the lateral aspect. I completed the plantar plate disruption and drilled 2 vertical tunnels into the base of the proximal phalanx of the 3rd toe. I then performed a Weil osteotomy and retracted the 3rd metatarsal head proximally and held it temporarily. I then accessed the plantar plate and placed 2 #2 FiberWires into the plantar plate. The tissue was healthy appearing. It had been released from the base of the proximal phalanx of the 3rd toe. Using a Smith and Nephew mini FirstPass, I then brought both sutures through the plantar plate. I then brought those sutures, 1 medial and 1 lateral, through the bone tunnels of the proximal phalanx. I then released the temporary fixation on the metatarsal and let it drift distally. I then tensioned the plantar plate appropriately, tied it down over the top of the proximal phalanx with the FiberWire, tying each strand to the other. I then brought the metatarsal head distally and translated it medially as well. This reduced the 3rd toe nicely. It had previously been in varus and was now well balanced and well aligned. I see I then utilized 2 Stryker 2.0 mm cortical screws for fixation of the metatarsal osteotomy and removed overhanging bone. There was a slight shortening ultimately of the metatarsal by about 2 to 3 mm. This then completed the construct. I was able to range the 3rd toe nicely. The shortening of the metatarsal functionally lengthened the extensor tendons just slightly, and I then shortened them with 2-0 Vicryl."
I'd really love some guidance as this has been an ongoing question in my group.