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question on a sx

  1. #1
    Default question on a sx
    Medical Coding Books
    My doctor did a sx for hammertoe deformity of the 2nd and 3rd digits of the left foot with associated partial dislocation of the 2nd metatarsophalangeal joint. He's asking if 28645 will work for open reduction of the dislocation at the second metatarsophalangeal joint. I don't think so because there was no internal fixation. Please give me your opinion on whether or not there is another code I can use with 28285/T1 and 28285/T2.

    Attention was directed to the proximal interphalangeal joint of the second and third digits where two contracted hammertoe deformities were noted with associated interdigital callus formation. Two converging semi-elliptical incisions were carried out over the level of these digits transverse to the longitudinal axis of the extensor tendons. The incisions were deepened through the skin and subcutaneous tissue. Two skin wedges were removed. The extensor tendons were transected transversely. The medial and lateral collateral ligaments were released. The plantar plates were released. The heads of the proximal phalanx were excised from the second and third digit. The wounds were copiously flushed. The forefoot was loaded, a more rectus alignment was noted at the forefoot, however, there was still dislocation of the second metatarsophalangeal joint. At this time, a small linear longitudinal incision was carried out at the level of the joint space. The extensor tendon was identified and transected transversely. The capsule was identified and incised. A freer elevator was used to free the plantar soft tissues and to realign the metatarsophalangeal joint. The forefoot was loaded. The ray sat in rectus alignment. The wounds were copiously flushed with sterile normal saline. The deeper soft tissue structures were reapproximated with a 2-0 vicryl in simple interrupted suture technique...etc

  2. #2
    High Point, NC
    I would be more inclined to use CPT 28270 since he incised the joint capsule and freed the tendons and soft tissue. It appears the dislocation was due to contracted tendons and not a traumatic dislocation.

    Hope this helps!
    Cindy Gallimore, CPC, CENTC

  3. #3
    Default question about sx
    Thanks. I thought about using that code but wanted to see what someone else thought.

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