Arthrodesis foot joints

nsteinhauser

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I would appreciate any thoughts anyone has on this.
Patient comes in for right tarsometatarsal joint fusion (initially would be 28740) and THEN the right 1st and 2nd cuneiform bones were pinned/screwed together. "There was widening of the joint with stress under c arm fluoroscopy. Patient had a hypermobile foot. Therefore, a k wire was placed medial to lateral across the 1-2 cuneiform joint. We over reamed the proximal aspect of the pin. We then used a countersink on the medial aspect of the bone. A 23mm x 3.5 mm transverse Lapiplasty screw was placed over the wire."
Does this additional 'fixing' of the 1-2 cuneiform bones after the fusion of the 1st tarsometatarsal support an additional 'arthrodesis'? Does screwing 2 bones together indicate a 'fusion' of that joint? So, would you then use a 28730 for 'multiple or transverse'?
If no, what would you use for the fixing of the 1-2 cuneiforms, in addition to the 28740?
Thank you for any and all ideas.
 

amyjph

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What was the diagnosis for doing that, just hypermobility? The lay description of 28730 says "any variety of friction devices to hold each joint in it's fused position". If the intent was immobilization of the cuneiform joint by joining them together with the screw and wire I think you could call it 28730.

If the procedure planned 28740 required pre-auth you'll probably have a tougher time getting paid if you report something else, but if that's what was done and it was an intraopertive decision you can try.
 

nsteinhauser

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What was the diagnosis for doing that, just hypermobility? The lay description of 28730 says "any variety of friction devices to hold each joint in it's fused position". If the intent was immobilization of the cuneiform joint by joining them together with the screw and wire I think you could call it 28730.

If the procedure planned 28740 required pre-auth you'll probably have a tougher time getting paid if you report something else, but if that's what was done and it was an intraopertive decision you can try.
That's what I was wondering - if joining the 2 bones together with a screw would still be considered 'fusion' for this purpose and it sounds like it does.
The fusion of the 1st tarso metatarsal was planned for "Hallux valgus deformity" but there was also a "right midfoot instablity" diagnosis. So maybe the possibility of additional fixation was already there.
Thanks!
 

amyjph

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That's what I was wondering - if joining the 2 bones together with a screw would still be considered 'fusion' for this purpose and it sounds like it does.
The fusion of the 1st tarso metatarsal was planned for "Hallux valgus deformity" but there was also a "right midfoot instablity" diagnosis. So maybe the possibility of additional fixation was already there.
Thanks!
You might want to look at 28297 for this combo if it was being done for hallux valgus depending on the exact joints and info in the op note.
 

nsteinhauser

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You might want to look at 28297 for this combo if it was being done for hallux valgus depending on the exact joints and info in the op note.
I looked at that but that only includes fusion of the first tarsometatarsal joint, correct? The first metatarsocuneiform? But it doesn't include the joining/fixation/fusion of the medial (1st) cuneiform to the intermediate (2nd) cuneiform, right? Thank you for your help!
 

amyjph

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It includes fusion of the first metatarsal and medial cuneiform (read the CPT description for more info and if you have a lay description like Encoder for it). Depending on the documentation and diagnoses, if the intent was correction of hallux valgus (bunion), it might be more appropriate. It doesn't specifically include 1-2 cuneiform fusion.
 
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