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Ostectomy, partial saucerization

bethh05

Expert
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I posted this on the ASC thread, also, being that I code for the facility. Any thoughts from a foot expert would be greatly appreciated!

Procedure: Ostectomy, partial with saucerization at the 2nd, 3rd metatarsocuneiform joint and the fourth metatarsocuboid joint, left foot, and excision of hypertrophic nodular synovium from Lisfranc joint

Description: A 3-cm lazy S-shaped incision was made beginning proximal to the lateral aspect of the talonavicular joint extending distally to the proximal one-third of the second metatarsal. This was done on the dorsum of the foot. The incision was deepened using blunt dissection and all vital structures were retracted. A dorsal linear incision was made into the Lisfranc joint at the level of the second and third metatarsocuneiform joints. Using sharp dissection and a periosteal elevator, the periosteal tissues and capsular structures were dissected to expose the base of the second metatarsal, third metatarsal, and fourth metatarsals and the associated cuneiforms and cuboid area. A transverse incision was made into the Lisfranc joint in these areas. Immediately, a large nodular violaceous soft tissue mass was identified to be lying within the second and third metatarsocuneiform joints. This was excised in toto and was consistent with a hypertrophic nodular synovitis. The hypertrophic bone was exposed and using an osteotome and mallet, this hypertrophic bone/exostosis was excised in toto on the base of the second, third, and fourth metatarsals and the distal end of the cuboid and second and third cuneiform bones at the joint level. Once this was removed, an osteotome and mallet were used to creat a saucerization of the joint surface in order to prevent any bony regrowth in this area.

I was going with 28122 x3, but was told that in 2010 exostosis coding changed to those in the bone cyst range, but he does perform the saucerization. Any thoughts? Thank You VERY much.
 

BCrandall

Guru
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I'm no foot expert, but I have podiatrists in our hospital and I stayed in a Holiday Inn Express. :D I don't know of anything about bone spurs being in with bone cysts, but I looked in my cross coder and 28122 seems to work with the exostosis ICD-9 (726.91).

Hope that helps!
 
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