Wiki Amputation MTP joint with shortening of metatarsal

k4lilly

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Hi,

Appreciate any help. Surgeon coded 28820 and 28308 for the second metatarsal. I don't feel like this is right. I looked at 28820 with 28111 and I've looked at 28810-52 and am unsure. Any thoughts?

The leg was exsanguinated and a fishmouth incision was made at the base of the 2nd
and 3rd MTP joints. This single incision was made through the skin and subcutaneous
tissue with a 15 blade, taking care to use a Bovie at the digital artery and vein to
control postoperative bleeding. The neurovascular structures were then sharply
incised with a 15 blade, and the amputation was continued through the extensor and
flexor tendons to the MTP capsule until both the 2nd and 3rd toes were completely
amputated at the 2nd and 3rd MTP joints. After this, the 2nd MTP joint which was
long and prominent plantarly was isolated. A 15 blade was used to resect some of the
plantar plate from the metatarsal head, and 2 Hohmann retractors were placed and held
by the assistant while the primary surgeon used a small saw and resected the 2nd
metatarsal head, then pulling out the rest of the bone with a rongeur followed by a
power rasp to smooth the 2nd metatarsal distally. This was then palpated to make
sure that all bony fragments were removed and that the edges of the resection were
smooth. Then an AP and lateral x-ray confirmed this as well. It was saved to
IMPAX, and then the surgical site was irrigated with sterile saline.


Thank you!
Kelly
 
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