excision of multiple coalitions 28116 x1 or x3?

Kelly_Josephine

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I am in ASC and this op report suggests that I might code multiple procedures for excision of multiple coalitions within one incision site. This case looks like it could be:
28116-RT, 76000-TC
or
28116-RT, 28116-59-RT, 28116-59-RT, 76000-TC

Does anyone have experience with how to code this case?

Here is the bulk of the op note:

POSTOPERATIVE DIAGNOSES
1. Right calcaneonavicular coalition.
2. Right calcaneocuboid coalition.
3. Naviculocuboid coalition.

OPERATION PERFORMED Resection of the tarsal coalition of:
1. The calcaneonavicular
2. Calcaneocuboid.
3. Cuboid naviculocuneiform.
4. Fluoroscopy and evaluation of images during surgery without the presence or report of radiologist

We made an anterolateral incision starting at the fibular tip going down to the 4th metatarsal base. We got down deeper preserving neurovascular structures. We elevated the extensor digitorum brevis preserving the neurovascular structures down to the peroneal tendons. So we came down to the coalition site.

We found that the coalition was more complex than it was seen on x- ray. So, there was a huge calcaneonavicular coalition and additional calcaneocuboid coalition on the medial side and also naviculocuboid coalition. Under fluoroscopy guidance, we did a nice excision of the cuboid and we had almost a normal range of motion of the subtalar joint at the end. After we were sure that all the coalition parts were out, we washed the joint side and put bone wax at the bleeding surfaces also to act as a barrier for recurrence, and after copious irrigation of muscles again, we closed the subcutaneous tissue using 2 and 3-0 Vicryl sutures and skin with 3-0 nylon sutures. We placed the patient in a CAM boot. There were no complications.​

My encoder description reads: "...The provider excises the bridge of tissue joining the two bones and debrides or smooths the bones..." so I am thinking that I should actually report this code 3x since three pairs of bones are being addressed. So far, I don't find anything searching the web for coding excision of coalition of more than two bones, but my gut says to use just one code. HELP!
 
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