lburgos31
Guest
I am not well prepared for foot procedures. When I look up these codes 28292,28306,28310 they all seem inclusive to each other. I am not sure if they should all be billed or only one since they are inclusive.
Feedback welcomed!!!
PROCEDURES:
1. Bunionectomy with distal soft tissue release.
2. Proximal first metatarsal osteotomy.
3. Osteotomy, proximal phalanx, great toe.
A 58-year-old male with a symptomatic
hallux valgus, left foot, not better with nonoperative care. After
discussion with the patient regarding the risks, benefits, alternatives,
expectations, and expected postop plan of care for the above-noted
procedure, he elected to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the Operating Room,
placed in supine position on the Operating Room table. After satisfactory
establishment of general anesthesia, first ray block was established with
0.5% Marcaine and 1% lidocaine mixture. Left lower extremity prepped and
draped in usual sterile fashion using ChloraPrep and stockinette. Ancef
administered intravenously. The left foot and ankle were exsanguinated
with an Esmarch bandage, which was left around the ankle as a tourniquet.
Dorsal longitudinal incision was made in the first web distally through
skin and subcutaneous tissue and hemostasis obtained as needed throughout
procedure with electrocautery. Care was taken to protect subcutaneous
neurovascular and tendon structures throughout the procedure as well. The
adductor tendon was released from its insertion on the fibular sesamoid
and lateral capsulotomy of the first metatarsophalangeal joint performed.
First, MTP joint could be corrected to approximately 30 degrees of varus
at this time. Two sutures of 2-0 Vicryl were placed incorporating first
metatarsal head capsule, adductor tendon, and second metatarsal head
capsule and left for later tying. Saline moistened gauze sponge was
placed in the wound.
A longitudinal incision was made over the medial eminence and the medial
capsule isolated. Capsulotomy was performed and using osteotome
bunionectomy was performed in line with the first metatarsal shaft 1 mm
medial to the sagittal sulcus. Edges were smoothed with a rongeur. First
metatarsophalangeal joint was without significant degenerative change.
Wound was packed with saline-moistened sponge.
Dorsal longitudinal incision was made over the proximal first metatarsal
and the extensor tendon identified and retracted. Using the crescentic
saw blade, osteotomy of the first metatarsal was performed. The osteotomy
was placed in a corrected position and provisionally held with a K-wire.
A Synthes 3.5 cortex screw was then placed for definitive fixation across
the osteotomy with good correction and fixation. Check with the C-arm at
this time showed correction of the first-second intermetatarsal angle.
The first metatarsophalangeal joint was irrigated. The medial capsule was
repaired in a pants-over-vest fashion with interrupted 0 Vicryl with good
correction of the hallux valgus. Check with the C-arm showed satisfactory
correction of the first metatarsophalangeal joint with a congruent joint.
Hallux interphalangeus was identified. Decision was made to proceed with
proximal phalanx osteotomy. Using C-arm for guidance, osteotomy of the
proximal phalanx of the great toe was then performed using a small
sagittal saw. This was closing wedge osteotomy. A Synthes 3.0 cancellous
cannulated screw was used for fixation. Check with the C-arm at this time
showed satisfactory position of the great toe with a satisfactory position
of implants. Fixation was deemed to be stable throughout. Satisfactory
clinical position of the toe was present. With forefoot compression
applied, the sutures in the second web were tied. The wounds were
irrigated after removal of the tourniquet. The wounds were closed using
4-0 nylon mattress suture. Sterile dressings of Xeroform, 4 x 4's, Kling,
and Ace wrap were applied and a postoperative bunion-type dressing.
Postoperative shoe placed.
All sponge, needle, and instrument counts were correct. The patient
tolerated the procedure well and was received in the recovery room in
satisfactory condition.
Feedback welcomed!!!
PROCEDURES:
1. Bunionectomy with distal soft tissue release.
2. Proximal first metatarsal osteotomy.
3. Osteotomy, proximal phalanx, great toe.
A 58-year-old male with a symptomatic
hallux valgus, left foot, not better with nonoperative care. After
discussion with the patient regarding the risks, benefits, alternatives,
expectations, and expected postop plan of care for the above-noted
procedure, he elected to proceed.
DESCRIPTION OF PROCEDURE: The patient was brought to the Operating Room,
placed in supine position on the Operating Room table. After satisfactory
establishment of general anesthesia, first ray block was established with
0.5% Marcaine and 1% lidocaine mixture. Left lower extremity prepped and
draped in usual sterile fashion using ChloraPrep and stockinette. Ancef
administered intravenously. The left foot and ankle were exsanguinated
with an Esmarch bandage, which was left around the ankle as a tourniquet.
Dorsal longitudinal incision was made in the first web distally through
skin and subcutaneous tissue and hemostasis obtained as needed throughout
procedure with electrocautery. Care was taken to protect subcutaneous
neurovascular and tendon structures throughout the procedure as well. The
adductor tendon was released from its insertion on the fibular sesamoid
and lateral capsulotomy of the first metatarsophalangeal joint performed.
First, MTP joint could be corrected to approximately 30 degrees of varus
at this time. Two sutures of 2-0 Vicryl were placed incorporating first
metatarsal head capsule, adductor tendon, and second metatarsal head
capsule and left for later tying. Saline moistened gauze sponge was
placed in the wound.
A longitudinal incision was made over the medial eminence and the medial
capsule isolated. Capsulotomy was performed and using osteotome
bunionectomy was performed in line with the first metatarsal shaft 1 mm
medial to the sagittal sulcus. Edges were smoothed with a rongeur. First
metatarsophalangeal joint was without significant degenerative change.
Wound was packed with saline-moistened sponge.
Dorsal longitudinal incision was made over the proximal first metatarsal
and the extensor tendon identified and retracted. Using the crescentic
saw blade, osteotomy of the first metatarsal was performed. The osteotomy
was placed in a corrected position and provisionally held with a K-wire.
A Synthes 3.5 cortex screw was then placed for definitive fixation across
the osteotomy with good correction and fixation. Check with the C-arm at
this time showed correction of the first-second intermetatarsal angle.
The first metatarsophalangeal joint was irrigated. The medial capsule was
repaired in a pants-over-vest fashion with interrupted 0 Vicryl with good
correction of the hallux valgus. Check with the C-arm showed satisfactory
correction of the first metatarsophalangeal joint with a congruent joint.
Hallux interphalangeus was identified. Decision was made to proceed with
proximal phalanx osteotomy. Using C-arm for guidance, osteotomy of the
proximal phalanx of the great toe was then performed using a small
sagittal saw. This was closing wedge osteotomy. A Synthes 3.0 cancellous
cannulated screw was used for fixation. Check with the C-arm at this time
showed satisfactory position of the great toe with a satisfactory position
of implants. Fixation was deemed to be stable throughout. Satisfactory
clinical position of the toe was present. With forefoot compression
applied, the sutures in the second web were tied. The wounds were
irrigated after removal of the tourniquet. The wounds were closed using
4-0 nylon mattress suture. Sterile dressings of Xeroform, 4 x 4's, Kling,
and Ace wrap were applied and a postoperative bunion-type dressing.
Postoperative shoe placed.
All sponge, needle, and instrument counts were correct. The patient
tolerated the procedure well and was received in the recovery room in
satisfactory condition.