I need help with the following Operative report. The physican states this is for pseudomacrodactyly,however the operative report does not seem to support the use of CPT code 28340/28341. Any suggestions as to which code would be more appropriate?
Procedure #1, reconstruction/revision right hallux deformity for pseudomacrodactyly. Attention was directed to the right hallux where there was a significantly large tuft of skin over the plantar lateral aspect of the hallux underlapping the second toe. The toe was irregular, there was very prominent boney deformity at the dorsal medial hallux IPJ as well as somewhat laterally. A long curvilinear incision was made almost fishmouth like around the tip of the hallux, preserving the remainder of the nail by apparatus from lateral to medial, a large connecting semi-elliptical skin wedge was taken laterally, smaller medially. The skin wedge was removed in toto down to the subcutaneous tissue level. Dissected was then perfromed down to bone and the distal phalanx and the medial and lateral interphalangeal joint was exposed. The remaining portion of distal phalanx and the interphalangeal joint on the medial aspect were exposed. Utilizing a rongeur and a power sagittal saw, the prominent boney deformity was removed and remodeled. A FluoroScan was used to guide the amount of appropriate bone resection in an effort to reconstruct the distal phalanx and minimize any further shortening of the hallux. After that, the bone resection was completed. The area was smoothed with a hand rasp. The toe was irrigated with copious amounts of normal sterile saline. The skin was then reapproximated utilizing 4-0 nylon in interrupted horizontal mattress and simple interrupted fashion. Multiple revisions were made on the skin flaps in attempt to normalize the appearance of the great toe as much as possible. Approximately one hour of OR time was spent to perform this procedure due to the significance of the presenting great toe deformity and the required bone resection/remodeling along with removal of substantial skin wedges and flaps with complex wound closure.
Procedure #1, reconstruction/revision right hallux deformity for pseudomacrodactyly. Attention was directed to the right hallux where there was a significantly large tuft of skin over the plantar lateral aspect of the hallux underlapping the second toe. The toe was irregular, there was very prominent boney deformity at the dorsal medial hallux IPJ as well as somewhat laterally. A long curvilinear incision was made almost fishmouth like around the tip of the hallux, preserving the remainder of the nail by apparatus from lateral to medial, a large connecting semi-elliptical skin wedge was taken laterally, smaller medially. The skin wedge was removed in toto down to the subcutaneous tissue level. Dissected was then perfromed down to bone and the distal phalanx and the medial and lateral interphalangeal joint was exposed. The remaining portion of distal phalanx and the interphalangeal joint on the medial aspect were exposed. Utilizing a rongeur and a power sagittal saw, the prominent boney deformity was removed and remodeled. A FluoroScan was used to guide the amount of appropriate bone resection in an effort to reconstruct the distal phalanx and minimize any further shortening of the hallux. After that, the bone resection was completed. The area was smoothed with a hand rasp. The toe was irrigated with copious amounts of normal sterile saline. The skin was then reapproximated utilizing 4-0 nylon in interrupted horizontal mattress and simple interrupted fashion. Multiple revisions were made on the skin flaps in attempt to normalize the appearance of the great toe as much as possible. Approximately one hour of OR time was spent to perform this procedure due to the significance of the presenting great toe deformity and the required bone resection/remodeling along with removal of substantial skin wedges and flaps with complex wound closure.