Case # 17 clinical added to Answer key & Rationale
Case # 17 clinical added to Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.
ANSWER KEY
CPT: 28285, 28285
CPT Modifiers: T6, T7
ICD-9: 735.4, 727.42
RATIONALE
The provider performs a repair of hammertoe on two toes. The removal of the ganglion cyst is bundled with the hammertoe repair. If the procedures were performed on different toes, the ganglion procedure could be reported but in this case the procedures were performed on the same toes. Modifier 59 is the modifier of last resort. Because anatomic modifiers are more specific in this case, append with modifiers T6 and T7.
CPT: 28285-T6, 28285-T7
Steps to look up: Hammertoe Repair/Correction
ICD-9-CM: 735.4, 727.42
Steps to look up: Hammer toe (acquired); Ganglion
Hint: This one is an outpatient procedure for a patient presenting hammertoe. The lookup steps are different from ICD-9-CM to ICD-10 on this one. Lay terms will also prove useful.
Case# 17
Surgeon:
Assistants: none
Pre-op Diagnosis:
1) Hammertoe deformity, 2nd & 3rd toes right
2) Ganglion cysts 2nd & 3rd toes right
Post-op Diagnosis:
1) Hammertoe deformity, 2nd & 3rd toes right
2) Ganglion cysts 2nd & 3rd toes right
Procedure:
1) Hammertoe correction, 2nd & 3rd toes right
2) Excision of ganglion cysts, 2nd & 3rd toes right
Anesthesia: local anesthesia with IV sedation
Hemostasis: ankle tourniquet at 250mm Hg for 30 minutes. right
Estimated Blood Loss: less than 5 cc
Materials: none
Injectables: 1:1 mix, 10 cc, lidocaine 1% and Marcaine 0.5%.
Pathology: no specimen sent
Indications: The more common risks, benefits, and alternatives to the procedure were discussed with the patient. The consent form was signed. The patient stated that he understood the procedures that will be performed and the possible complications which include, but are not limited to pain, swelling, recurrence, delay or lack of healing, loss of toe or foot, worsening of the condition, fracture and scar formation.
Procedure: This 60-year-old male was brought to the operating room and placed on the OR table in a supine position. Following anesthesia and hemostasis, the surgical site was prepped and draped in the usual sterile fashion. Attention was then directed to the right foot.
Two 1 cm transverse semi-elliptical incisions were made over the dorsal distal (DIP) interphalangeal joint 2nd digit. This skin was removed exposing an underlying ganglion cyst. The cyst was isolated and carefully excised and removed in total from the extensor tendon. A transverse tenotomy was then performed over the distal (DIP) interphalangeal joint, and the tendon was underscored proximally from the middle phalanx. The head of the middle phalanx was freed from soft tissue attachments and was resected using a sagittal saw. The bone was rasped smooth and the surgical site copiously irrigated with sterile saline. The tendon and capsular tissues were repaired using 4-0 Vicryl simple sutures. Skin closure was performed with 4-0 Prolene in a horizontal suture mattress fashion.
Attention was directed to the 3rd toe where two 1 cm. transverse semi-elliptical incisions were made over the dorsal proximal (PIP) interphalangeal joint 3rd digit. This skin was removed exposing an underlying ganglion cyst. The cyst was isolated and carefully excised and removed in total from the extensor tendon. A transverse tenotomy was then performed over the proximal (PIP) interphalangeal joint, and the tendon was underscored proximally from the head of the proximal phalanx. The head of the proximal phalanx was freed from soft tissue attachments and was resected using a sagittal saw. The bone was rasped smooth and the surgical site copiously irrigated with sterile saline. The tendon and capsular tissues were repaired using 4-0 Vicryl buried simple sutures. Skin closure was performed with 4-0 Prolene in a horizontal suture mattress fashion.
A light compressive dressing was applied. The tourniquet was released and good color returned to the right foot and digits. The patient tolerated procedure and anesthesia well. Vital signs were stable. The patient was dispensed a surgical shoe with instructions on use. The patient is to keep the foot elevated and apply an ice pack on the ankle area for the initial 48 hours. The patient is to keep the dressing clean and dry. The patient is to call if there are any concerns or problems.
https://www.aapc.com/code/aapc-coding-challenge/cases.aspx