dsibley67
Networker
This op note has me stumped. The physician wants to code it as a 28299. I don't see any bone work being done. All I see is the TightRope work. I am leaning toward 28238 & 28313, but I would like a second opinion. Any help will be greatly appreciated.
POSTOPERATIVE DIAGNOSIS: Hallux varus, 22-modifier.
PROCEDURES PERFORMED: Correction hallux varus with modified McBride soft tissue release
and TightRope insertion, left, revision work extra time 22-modifier.
PROCEDURE IN DETAIL: The patient was identified and placed on the treatment table in supine
position. Following general endotracheal intubation, left foot was scrubbed, prepped and draped in usual
aseptic manner. Attention directed to prior cicatrix as this was prior procedure done years ago and the
patient developed hallux varus. Two converging semi-elliptical incisions were used for over the prior
cicatrix and removed from the field in its entirety. Soft tissue released down to the scar tissue from medial
and lateral joint. We did a medial open capsulorrhaphy to assist with decompression of the medial pole.
We found the abductor fascia and distal abductor insertion and released it down to the medial portion just
dorsal to the medial sesamoid. The toe floated in more corrected anatomic alignment at this point.
Attention was directed to the interspace where soft tissues were released around the lateral capsule.
Tightening of lateral capsule gently performed with 2-0 Vicryl. We then did retention of a TightRope
through K-wire and drill hole from distal medial on the proximal phalanx exiting proximal lateral on the
distal phalanx and then reentering the distal lateral portion of first met head, exiting proximal medial to the
metadiaphyseal junction of first metatarsal. Button was then reinserted over the suture from the medial
aspect of the TightRope on the first metatarsal. Toe was floated in a more corrected anatomic alignment
retained. We challenged the foot to move back in varus through pressure and weightbearing and tightened
the TightRope on the button of the medial first metatarsal. Overcorrection was prohibited by allowing
small lateral movement in the first metatarsal and first metatarsophalangeal joint, tightening the TightRope,
however prevented any retention and kept the toe vertical versus varus. TightRope was cut at this point.
We irrigated with normal sterile saline, closed the periosteal layer with 2-0 Vicryl, subcutaneous stitch with
3-0 Vicryl and skin closed with 4-0 nylon. X-rays were taken during the course to visualize angle and
button placement which was excellent.
POSTOPERATIVE DIAGNOSIS: Hallux varus, 22-modifier.
PROCEDURES PERFORMED: Correction hallux varus with modified McBride soft tissue release
and TightRope insertion, left, revision work extra time 22-modifier.
PROCEDURE IN DETAIL: The patient was identified and placed on the treatment table in supine
position. Following general endotracheal intubation, left foot was scrubbed, prepped and draped in usual
aseptic manner. Attention directed to prior cicatrix as this was prior procedure done years ago and the
patient developed hallux varus. Two converging semi-elliptical incisions were used for over the prior
cicatrix and removed from the field in its entirety. Soft tissue released down to the scar tissue from medial
and lateral joint. We did a medial open capsulorrhaphy to assist with decompression of the medial pole.
We found the abductor fascia and distal abductor insertion and released it down to the medial portion just
dorsal to the medial sesamoid. The toe floated in more corrected anatomic alignment at this point.
Attention was directed to the interspace where soft tissues were released around the lateral capsule.
Tightening of lateral capsule gently performed with 2-0 Vicryl. We then did retention of a TightRope
through K-wire and drill hole from distal medial on the proximal phalanx exiting proximal lateral on the
distal phalanx and then reentering the distal lateral portion of first met head, exiting proximal medial to the
metadiaphyseal junction of first metatarsal. Button was then reinserted over the suture from the medial
aspect of the TightRope on the first metatarsal. Toe was floated in a more corrected anatomic alignment
retained. We challenged the foot to move back in varus through pressure and weightbearing and tightened
the TightRope on the button of the medial first metatarsal. Overcorrection was prohibited by allowing
small lateral movement in the first metatarsal and first metatarsophalangeal joint, tightening the TightRope,
however prevented any retention and kept the toe vertical versus varus. TightRope was cut at this point.
We irrigated with normal sterile saline, closed the periosteal layer with 2-0 Vicryl, subcutaneous stitch with
3-0 Vicryl and skin closed with 4-0 nylon. X-rays were taken during the course to visualize angle and
button placement which was excellent.