Preoperative Diagnosis:
1. Osteomyelitis, right foot
2. Chronic ulcer of right foot.
3. Foreign body, deep in right foot, sewing needle or straight pin

Procedures Performed:
1. Complete ostectomy of the right great metatarsal head
2. Partial ostectomy of the right great proximal phalanx
3. Removal of foreign body, complicated, deep in the right foot joint of the metatarsophalangeal joint.

Description of Procedure:
A sharp incision was made in the dorsum of the foot longitudinally overlying the great metatarsal head, proximal phalanx and shaft, both proximal phalanx and metatarsus. We incised sharply down to the bone, used the periosteal elevator to elevate the soft tissues from the bone. Then , divided the bone proximal to the metatarsal head with an oscillating saw, divided the bone distal to the metatarsophalangeal joint with an oscillating saw in the proximal phalanx. We first removed the metatarsal head with sharp excision and then removed the proximal phalanx with sharp excision to the cartilaginous attachments at which point we found the foreign body lying within the joint space, this was alo removed in its entirety. Due to the proximity of pisiform bone to the original ulcer, we decided to remove this as well and sharply excised it from the flexor tendon, sent it to pathology to ensure we did not leave behind any infected bone. Curettes were used to curette the soft tissue fistulas that were in place, 1 on the plantar aspect of the foot, 1 on the medial aspect of the foot. The soft tissue from the curettage was sent for culture material. Copious irrigation was performed. We then closed our incision longitudinally...........


Physician wants to use 28111, 28124, 28193. This is a Medicare patient and these are bundled. I know that 28193 is included and should be billed separately since report does not really show separate significant work.
Is 28124 included in the 28111? Or could 28120 and 28124 be used?

Thanks for your help.