KayleyReinhard
New
We are trying to determine whether to use 38232 or 20900 for bone marrow aspirate used for first metarsophalangeal joint arthrodesis. The podiatry coder thinks we should use 38232 because the podiatrist did not state that they used a bone graft, but my understanding is that the bone marrow aspirate IS the bone graft, and that 38232 is used for treatment of blood disorders/cancers.
"Attention was then first directed to the left heel. The bony landmarks of the left lateral calcaneus were palpated. An 18 gauge syringe was then advanced percutaneously into the body of the calcaneus and 4 mL of bone marrow aspirate was obtained and passed to the back table. An Esmarch was then used to exsanguinate the left foot and the tourniquet was inflated.
Attention was then directed to the left forefoot. A dorsomedial incision was created along the first metatarsophalangeal joint. The incision was deepened to the level of the joint capsule taking care to cauterize any crossing veins. The extensor hallucis longus tendon was identified and retracted laterally. A longitudinal incision was then deepened through the joint capsule to the level of bone medial to the extensor tendon. The joint capsule was then raised from the first metatarsal head and the base of the proximal phalanx to allow full visualization of the first metatarsophalangeal joint. There was approximately 90% loss of articular cartilage to the first metatarsal head and dorsal osteophyte formation to the first metatarsal head. The joint surfaces of the first metatarsal head and base of the proximal phalanx were then prepared with a power reamer. The remaining cartilage was removed with a combination of rongeur and burr until bleeding cancellous bone was visualized. The joint surfaces were then fenestrated with a 2 mm drill. The surgical site was then irrigated. The previously harvested bone marrow aspirate was then applied to the arthrodesis site."
Thanks in advance.
"Attention was then first directed to the left heel. The bony landmarks of the left lateral calcaneus were palpated. An 18 gauge syringe was then advanced percutaneously into the body of the calcaneus and 4 mL of bone marrow aspirate was obtained and passed to the back table. An Esmarch was then used to exsanguinate the left foot and the tourniquet was inflated.
Attention was then directed to the left forefoot. A dorsomedial incision was created along the first metatarsophalangeal joint. The incision was deepened to the level of the joint capsule taking care to cauterize any crossing veins. The extensor hallucis longus tendon was identified and retracted laterally. A longitudinal incision was then deepened through the joint capsule to the level of bone medial to the extensor tendon. The joint capsule was then raised from the first metatarsal head and the base of the proximal phalanx to allow full visualization of the first metatarsophalangeal joint. There was approximately 90% loss of articular cartilage to the first metatarsal head and dorsal osteophyte formation to the first metatarsal head. The joint surfaces of the first metatarsal head and base of the proximal phalanx were then prepared with a power reamer. The remaining cartilage was removed with a combination of rongeur and burr until bleeding cancellous bone was visualized. The joint surfaces were then fenestrated with a 2 mm drill. The surgical site was then irrigated. The previously harvested bone marrow aspirate was then applied to the arthrodesis site."
Thanks in advance.
