bethanne46
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Provider states he performed left foot hammertoe repair on 2nd, 3rd and 5th (28285) and then metatarsal head excision on 2nd 3rd, 4th and 5th (28114). I am having a hard time coding this one. I don't see a proximal phalangectomy documented here. And it sort of looks connected. I am new to podiatry. Any help is appreciated.
Attention was then turned to the lesser toes where transverse incisions were made over the PIP
joints of the 2nd, 3rd, and 5th toes. The 4th toe had been partially amputated and appeared
adequately aligned. The joint was resected with a sagittal saw. The flexor tendon identified
through the dorsal incision and cut. This was done for the 2nd, 3rd, and 5th toes. Once this was
done, attention was turned to the MTP joints where a longitudinal incision was made in the 2-3
interspace and in the 4-5 interspace. Dissection was carried down to the level of the extensor
tendons. The extensor tendons were lengthened between the longus and brevis. Once this was
done, a McGlamry elevator was used to release the plantar tissues after a transverse capsulotomy
was performed for the 2nd, 3rd, 4th, and 5th metatarsophalangeal joints. The sagittal saw was
then used to resect each of the metatarsal heads in an oblique cut. The metatarsal heads were
then resected. Once this was done, attention was turned to fixation. The K-wires were placed
across the PIP joints and then retrograded through the proximal phalanx and into the metatarsal
shaft. Fluoroscopy was used to assess pin placement and alignment. The 3rd ray K-wire was
found to be intramedullary distally but then exited more proximally, but excellent fixation and
alignment was achieved and therefore it was left in place. The pins were cut and capped.
Wounds were copiously irrigated with normal saline. Extensor tendons were repaired with 2-0
Vicryl.
Attention was then turned to the lesser toes where transverse incisions were made over the PIP
joints of the 2nd, 3rd, and 5th toes. The 4th toe had been partially amputated and appeared
adequately aligned. The joint was resected with a sagittal saw. The flexor tendon identified
through the dorsal incision and cut. This was done for the 2nd, 3rd, and 5th toes. Once this was
done, attention was turned to the MTP joints where a longitudinal incision was made in the 2-3
interspace and in the 4-5 interspace. Dissection was carried down to the level of the extensor
tendons. The extensor tendons were lengthened between the longus and brevis. Once this was
done, a McGlamry elevator was used to release the plantar tissues after a transverse capsulotomy
was performed for the 2nd, 3rd, 4th, and 5th metatarsophalangeal joints. The sagittal saw was
then used to resect each of the metatarsal heads in an oblique cut. The metatarsal heads were
then resected. Once this was done, attention was turned to fixation. The K-wires were placed
across the PIP joints and then retrograded through the proximal phalanx and into the metatarsal
shaft. Fluoroscopy was used to assess pin placement and alignment. The 3rd ray K-wire was
found to be intramedullary distally but then exited more proximally, but excellent fixation and
alignment was achieved and therefore it was left in place. The pins were cut and capped.
Wounds were copiously irrigated with normal saline. Extensor tendons were repaired with 2-0
Vicryl.
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