unlisted 28899 or 28289 with 28293 59
A dorsomedial incision was made over the first MTP joint. Blunt dissection was carried down through the subcutaneous tissue. A dorsal capsulotomy was performed. A capsular release was performed medially, laterally, and dorsally. There were multiple loose bodies noted within the joint, small, 1 to 2 mm. In addition, there were peripheral osteophytes noted. At this point, using a combination of micro oscillating saw and rongeur, the medial, dorsal, and lateral osteophytes were removed. There were degenerative changes primarily on the base of the proximal phalanx. A small chondral defect was noted on the distal end of the metatarsal head.
Peripheral osteophytes on the base of the proximal phalanx were resected. The area was sized to a 17 mm implant. Based on C-arm guidance, a guide wire was placed down the middle of the proximal phalanx. The base of the proximal phalanx was then hand reamed down to subchondral bone. A trial implant was inserted, which showed good alignment and position.
The trial was removed. The broach was inserted. An Arthrex first proximal phalanx replacement was press fitted into position. Good approximation with the bone was obtained.
The doc wants to use 28289 with 28293 but I have other research says that because it is not a bunion I should not use the 28289 and 28293 and go unlisted. Does anyone have documentation on this??
dx is 725.2 and 715.37
A dorsomedial incision was made over the first MTP joint. Blunt dissection was carried down through the subcutaneous tissue. A dorsal capsulotomy was performed. A capsular release was performed medially, laterally, and dorsally. There were multiple loose bodies noted within the joint, small, 1 to 2 mm. In addition, there were peripheral osteophytes noted. At this point, using a combination of micro oscillating saw and rongeur, the medial, dorsal, and lateral osteophytes were removed. There were degenerative changes primarily on the base of the proximal phalanx. A small chondral defect was noted on the distal end of the metatarsal head.
Peripheral osteophytes on the base of the proximal phalanx were resected. The area was sized to a 17 mm implant. Based on C-arm guidance, a guide wire was placed down the middle of the proximal phalanx. The base of the proximal phalanx was then hand reamed down to subchondral bone. A trial implant was inserted, which showed good alignment and position.
The trial was removed. The broach was inserted. An Arthrex first proximal phalanx replacement was press fitted into position. Good approximation with the bone was obtained.
The doc wants to use 28289 with 28293 but I have other research says that because it is not a bunion I should not use the 28289 and 28293 and go unlisted. Does anyone have documentation on this??
dx is 725.2 and 715.37