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Over hang skin incision, release of tendon, partial resection and release of capsule

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Pre-operative Diagnoses: 1. Posttraumatic deformity of the right big
toe (interphalangeal avulsion fracture of
the tendon)
2. Stiffness
3. Flexion deformity
Post-operative Diagnoses: 1. Posttraumatic deformity of the right big
toe (interphalangeal avulsion fracture of
the tendon)
2. Stiffness
3. Flexion deformity
Procedures: 1. Correction deformity of the right big toe
(interphalangeal joint of the right big toe)
2. Tendon release, capsular release and
excision partially anterior and posterior
4. Adhesion resection and release
5. Overhanging skin excision
6. Application of temporary fixation of the interphalangeal joint of the right big toe.


e started our procedure by exploration of the right big toe position of the right big toe is in flexion about 30º deformity with stiffness in the interphalangeal joint of the right big toe. ____Tic-tac incision was made in line to the dorsal big toe in the level of the interphalangeal joint. Then, swing incision lateral and medially done. Presentation of the adhesions and presentation of the extensor tendon which was a______ed then release the ____wound from proximal to the distal part with avulsion fracture_______. Excision of the overhanging capsules from anterior part and extended the overhang. Laterally posterior wound incision then a partial release performed to the capsule _____plantar. Manipulation of the joint was done. We get movements. At the end we get the correct position with full flexion and extension of the interphalangeal joint of the right big toe. At this stage we resected the osteophytes posteriorly and anteriorly and at the end we fixed our position with the correct position with _____temporal K-wires retrograde for the in phalanx ____taped to the inter phalanx. We documented our results with the fluoroscopy then suturing the medial collateral ligament was done and the skin was closed with nylon 3-0 after excision of the overhanging skin. A bandage was applied. The K-wires are passing through the skin outside. The procedure was then concluded.

Can you any one please help me to code the procedure..??
 

draung

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5
Location
Tucson
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there is a lot of fluff language in the pre and post op diagnosis, also the procedures described have been unbundled. The procedures listed 1,2,3,4,5,6 are all part of one procedure to repair a deviated or contracted toe it appears. It does not matter how the skin incision is made, or that adhesions are removed to get to the deformity, this is included in the procedure - unless the adhesions either caused a lenthening of the operating time due to difficuluties - which is hard to do in a toe. Also fixation is not paid seperately to fix a deformity - fixation is included in the proceure. It appears that some bone resection and soft tissue release is performed. if this is done on any other toe it would appear the closest to a hammertoe correction 28285 - look up this code and read the description and see if this matches the procedure described for the big toe - I believe it is the closest description of the entire procedure noted . you can also code it just as excision of bone cysts - exostectomy but RVU is lower, and just a capsule repair - which is only soft tissue does not reflect the procedure in its entireity. Hope this helps. Flouroscopy is also not seperately billable.
 
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