anwalden
Guest
I have another case that's new to me that I was hoping for some clarification on. The doctor wants to code 26531, which is the correct procedure, but for fingers, not toes. He's telling me that since they don't have one for toes, we should use the finger one. The rep that brought the implant says for the 2nd metatarsal head we should be using 28112 with a -22 modifier. I'm relatively sure that -22 is not an ASC approved modifier. Any thoughts?
See the Op note below:
PREOPERATIVE DIAGNOSIS: Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot.
POSTOPERATIVE DIAGNOSIS: Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot.
PATHOLOGY: None.
PROCEDURE: Arthroplasty with hemi-joint implant of the right second metatarsophalangeal joint.
ANESTHESIA: MAC.
HEMOSTASIS: Pneumatic calf tourniquet at 250 mmHg for 17 minutes.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
CONDITION OF THE PATIENT: Stable.
PROCEDURE: The patient was transferred from the preoperative holding area to the operating room where the patient was placed on the table in the supine position, at which time, the right lower extremity was prepped and draped in the usual sterile technique.
Attention was directed to the dorsal metatarsophalangeal joint where a linear incision was made medial and parallel to the tendon. The capsular structure was then incised as well, and the soft tissue was freed off the second metatarsal head. Next, a guidewire was placed, and confirmed with C-arm, in the medullary canal. Next, the taper post drill hole was made and the guide hole was also done. The taper post was placed and noted to be excellent. The sizing cap was then also placed and noted to be very good. Next, the metatarsal head was sized and the implant was 1 x 1 x 2 cm. The second metatarsal cartilage was then prepped. The reaming prominent cartilage was removed with a rongeur and the implant was then pre-sized and then place. There was noted to be excellent range of motion with the second metatarsophalangeal joint, as well as placement. There was no angulated deformity.
The tourniquet was deflated. The wound was irrigated. The capsule was closed with Vicryl, the subcutaneous tissue was closed with Vicryl, and the skin with Prolene. Sterile dressings were then applied. The patient was then transferred from the operating room to the PACU with vital signs stable and vascular status intact. There were no complications encountered on the case. The patient tolerated both the anesthesia and the procdure well.
See the Op note below:
PREOPERATIVE DIAGNOSIS: Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot.
POSTOPERATIVE DIAGNOSIS: Degenerative joint disease with avascular necrosis of the dorsal second metatarsal head of the right foot.
PATHOLOGY: None.
PROCEDURE: Arthroplasty with hemi-joint implant of the right second metatarsophalangeal joint.
ANESTHESIA: MAC.
HEMOSTASIS: Pneumatic calf tourniquet at 250 mmHg for 17 minutes.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
CONDITION OF THE PATIENT: Stable.
PROCEDURE: The patient was transferred from the preoperative holding area to the operating room where the patient was placed on the table in the supine position, at which time, the right lower extremity was prepped and draped in the usual sterile technique.
Attention was directed to the dorsal metatarsophalangeal joint where a linear incision was made medial and parallel to the tendon. The capsular structure was then incised as well, and the soft tissue was freed off the second metatarsal head. Next, a guidewire was placed, and confirmed with C-arm, in the medullary canal. Next, the taper post drill hole was made and the guide hole was also done. The taper post was placed and noted to be excellent. The sizing cap was then also placed and noted to be very good. Next, the metatarsal head was sized and the implant was 1 x 1 x 2 cm. The second metatarsal cartilage was then prepped. The reaming prominent cartilage was removed with a rongeur and the implant was then pre-sized and then place. There was noted to be excellent range of motion with the second metatarsophalangeal joint, as well as placement. There was no angulated deformity.
The tourniquet was deflated. The wound was irrigated. The capsule was closed with Vicryl, the subcutaneous tissue was closed with Vicryl, and the skin with Prolene. Sterile dressings were then applied. The patient was then transferred from the operating room to the PACU with vital signs stable and vascular status intact. There were no complications encountered on the case. The patient tolerated both the anesthesia and the procdure well.
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