Bunionectomy / Osteotomy


Fort Worth Texas
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Can someone please assist me with coding this op note. I struggle with using 28290 and 28296 or do I just use 28299. Any advice would be appreciated! Thanks!!

Procedure: Modified McBride bunionectomy with Austin osteotomy

Technique: Under general anesthesia the following procedures were performed. The patient's feet and ankles were prepped and draped in the usual aseptic manner. A pneumatic cuff was used for hemostasis.

In the first procedure a 7.0 cm. longitudinal incision was made over the dorsal aspect of the first right metatarsophalangeal joint just medial to the extensor hallucis longus tendon. The incision was deepened, vital structures retracted. Subcutaneous tissue was underscored. Small bleeders were cauterized. An inverted "L" incision was made on the medial dorsal aspect of the first right metatarsophalangeal joint capsule. The capsule was reflected back, collateral ligaments severed, and the head of the metatarsal was exposed. The medial hyperostosis was resected and the bony surfaces rasped smooth. The incision was then retracted laterally and deepened in the first interspace, where the transverse metatarsal ligament was severed and the adductor hallucis tendon was tenotomized from the head of its insertion and transferred to the lateral aspect of the head of the first metatarsal. The head of the first metatarsal was identified, isolated, and a transverse "V" metaphyseal osteotomy was performed with the apex pointing distally. The distal portion of the metatarsal was protected laterally and plantarly and set back onto the osteotomy site, where it was stabilized using a 0.054 Kirschner wire from proximal dorsal medial to distal plantar lateral through the osteotomy site. The redundant bone On the medial aspect of the first metatarsal was resected and the bony surfaces rasped smooth. The wound was flushed with copious amounts of normal saline. Capsulorraphy was performed.
The capsule was closed with 2-0 Vicryl interrupted sutures. A C-arm radiograph was taken to determine alignment. Excellent alignment. The skin was approximated with 4-0 nylon continuous lock sutures....