AR2728
Expert
Patient had correction of haullx valgus with right first Metatarsal Osteotomy. Patient presents 1 week later with displacement of metatarsal capital fragment requiring return to OR for removal of hardware and revision/re-fixation of right first metatarsal. Physician states to bill as 28485 for the revision which is open treatment of metatarsal fracture with internal fixation. I'm just questioning if this is the appropriate CPT for the revision since this is following the ostoeotomy and not a fracture-I looked at 28322 for repair of nonunion/malunion metatarsal--but I'm not sure if this is correct either. Would really appreciate some guidance with this one. I've attached a portion of the op report.
Attention was then directed to the dorsal aspect of the right first metatarsal phalangeal joint where the absorbable sutures were removed as much as possible and a new incision was made using the same incision line. Careful dissection was made through this previous incision line so as not to traumatize further the tissues. The incision was made through the subcutaneous tissue with care being taken to identify and retract all vital neurovascular structures. At this time a longitudinal capsulotomy was performed to the first metatarsal phalangeal joint and the periosteal and capsular structures were inspected medially and laterally after the head and shaft of the first metatarsal. At this time the screws were promptly both removed and passed from the operative site. The osteotomy had not healed at this point and it was shifted back into anatomic alignment and held with temporary fixation using a K-wire. Next, a plate was fitted to the osteotomy and was bent to contour the metatarsal head. Next, the plate was adhered down to the bone using a tack pin. The most distal plate holes were then drilled and 2.7 screws were placed across here. These were 3 non-locking screws. Next, the most proximal hole was drilled and a locking 2.7 screw was placed in this hole and the remaining holes, with the exception of the compression hole over the osteotomy site were all drilled and filled with 2.7 locking screws. Assessment was checked with C-arm and this was noted to be satisfactory. The osteotomy was noted to be completely reduced and screw length was checked and noted to be satisfactory. At this time the tack pink and the temporary fixation was removed. The wound was flushed with Betadine and left to soak in the wound for 2 minutes. This was then flushed again with saline. Capsular closure was achieved with #3-0 Vicryl.
Attention was then directed to the dorsal aspect of the right first metatarsal phalangeal joint where the absorbable sutures were removed as much as possible and a new incision was made using the same incision line. Careful dissection was made through this previous incision line so as not to traumatize further the tissues. The incision was made through the subcutaneous tissue with care being taken to identify and retract all vital neurovascular structures. At this time a longitudinal capsulotomy was performed to the first metatarsal phalangeal joint and the periosteal and capsular structures were inspected medially and laterally after the head and shaft of the first metatarsal. At this time the screws were promptly both removed and passed from the operative site. The osteotomy had not healed at this point and it was shifted back into anatomic alignment and held with temporary fixation using a K-wire. Next, a plate was fitted to the osteotomy and was bent to contour the metatarsal head. Next, the plate was adhered down to the bone using a tack pin. The most distal plate holes were then drilled and 2.7 screws were placed across here. These were 3 non-locking screws. Next, the most proximal hole was drilled and a locking 2.7 screw was placed in this hole and the remaining holes, with the exception of the compression hole over the osteotomy site were all drilled and filled with 2.7 locking screws. Assessment was checked with C-arm and this was noted to be satisfactory. The osteotomy was noted to be completely reduced and screw length was checked and noted to be satisfactory. At this time the tack pink and the temporary fixation was removed. The wound was flushed with Betadine and left to soak in the wound for 2 minutes. This was then flushed again with saline. Capsular closure was achieved with #3-0 Vicryl.