Wiki osteoclasis resection arthroplasty

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littlelora

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I need some help with this one. I'm looking at the partial excision of bone, since this doesn't make mention of any previous fractures, I cannot use the non union or malunion repairs. Any help or advice is appreciated!

OP note:

A scalpel was used to make a longitudinal incision on the dorsal aspect of the 4th and 5th webspace. Disection was deepened through the fat, and bleeding points were coagulated. The extensor tendon of the 5th toe was identified and transected. There was a florid synovitis, which I excised. I then used the oscilating saw to resect the distal portion of the metatarsal shaft and after this a more through plantar synovectomy was performed. After cleaning out the joint, and having already resected the bone under fluoroscopic guidance, I completed the procedure by placing a pin from a proximal to distal direction, 0.45 kirschner pin out through the base of the proximal phalanx and into the tip of the toe. After confirming proper placement, I then in a distal to proximal direction placed a pin into the medullary canal of the 5th metatarsal shaft. after obtaining 3 view xrays showing intramedullary location of the fixation and clinically feeling the toe was well aligned, I completed the procedure by lavaging the wound.
 
The issue is what was he doing and why was he doing it? By that I mean what were the Preoperative and Postoperative Diagnoses, and what did he say was the Procedure in his terms. I can't tell from your information whether he was dealing with the 5th Metatarsophalangeal Joint for inflammation and/or synovitis, or something else. He doesn't say anything about whether he removed or preserved the 5th Metatarsal Head, or how much bone he removed from the metatarsal "shaft." Please provide more information.

Alan Pechacek, M.D.
 
His pre-op and post-op DX is RT 5th toe MTP synovitis. The procedure in his own words is osteoclasis RT 5th MTP (resection arthroplasty MTP with pinning.) The above Op report body is the entire op report minus the prepping and draping.
 
I am sorry to say that your surgeon has mixed up Orthopedic terminology in this procedure. By definition, "Osteoclasis" means to surgically create a fracture of a bone, usually to correct a deformity. This can be done by an open or closed technique. Yet he also uses the term "Resection Arthroplasty" of the MTP Joint, which means "removal" of the joint, i.e. removal of part(s) of the bone(s) making up the joint. In this particular case, this would imply removal of the metatarsal head, +/- the base of the proximal phalanx (which he does not mention doing). If he truly means Resection Arthroplasty, then he did an Ostectomy of the 5th MT Head, 28113, plus the Synovectomy of the MTP Joint, 28072, (I don't know how he could have accessed the plantar portion of the joint for synovectomy without removing the metatarsal head). But you would have to be careful in that either one of these procedures could "include" the other, i.e. be bundled. You would have to check the Coding Edits for this. If they are not "bundled," then you could add a Modifier to the lesser procedure, probably 51. The pin placement would be included in the procedure so as to maintain alignment/position of the toe until the soft tissues have healed sufficiently for it to be removed.

I hope this helps you.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 
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