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Hammertoe Case. What do you think?

  1. #1
    Location
    New Port Richey & Gulf to Bay
    Posts
    107
    Question Hammertoe Case. What do you think?
    Medical Coding Books
    My Fellow Coders,

    I was wondering if one of you could help me code this case. Despite clearing CCI edits, I am concerned that still some of the CPT codes I am coming up with are still included. Any pointers will be appreciated. Thanks for your help!

    My code selections:
    28285-T1 = 735.4
    28285-T2 = 735.4
    28122-LT = 736.70
    28122-LT = 736.70
    28270-LT = 736.70
    28270-LT = 736.70


    POSTOPERATIVE DIAGNOSES:
    1. HAMMERTOE 2ND AND 3RD DIGIT, LEFT FOOT.
    2. DEFORMED METATARSALS OF 2ND AND 3RD, LEFT FOOT.

    PROCEDURES PERFORMED:
    1. ARTHROPLASTY OF DIGIT 2 AND 3, LEFT FOOT.
    2. OSTEOTOMY AND SCREW FIXATION OF METATARSALS 2 AND 3, LEFT FOOT.

    MATERIALS USED: TWO 2.0 CORTICAL BONE SCREWS FROM WRIGHT MEDICAL AND TWO 0.045 K-WIRES.[/SIZE][/SIZE]

    Under mild sedation, the patient was brought into the operating room and placed on the OR table in the supine position. The Team of Anesthesia provided deeper sedation and the left foot was then anesthetized with approximately 10 ml of 1:1 mixture of 1% lidocaine plain and 0.5% Marcaine plain. At this time, the left foot was then scrubbed, prepped, and draped in the usual aseptic manner.

    Attention was directed to the dorsal left foot. A linear longitudinal incision was made over the PIPJ of the left 2nd digit. This incision was carried down deep using sharp and blunt dissection with care being taken to identify and retract all vital and neural structures. The tendon of extensor digitorum longus was identified and a wound cleaning was performed at this time. Exposing the head of the proximal phalanx, oscillating bone saw was then used to remove the head of the proximal phalanx. It was passed from the operative site. The bone rasp was then used to smooth down any sharp edges. At this point, the wound was flushed with copious amounts of normal saline. Attention was then directed to the 2nd MPJ where a linear longitudinal incision was made over this, approximately 1 cm proximal to the previous incision. This incision was carried down using sharp and blunt dissection with care being taken to identify and retract all vital, neural and vascular structure. At this time, the tendon of extensor digitorum longus was identified and retracted and the capsule was identified and dorsal, medial and lateral capsulotomies were performed and _____ plate release with McGlamry elevator was performed. At this time, the 2nd metatarsal head was identified and freed up dorsally. Sagittal bone saw was then used to make a cut from dorsal distal to plantar proximal. After the cut, the head of the metatarsal seemed to have popped back into a more corrected position. At this time, the head was held in the corrected position with a 0.045 K-wire from the set. At this time, a 2.0 cannulated screw from the Wright Medical screw measuring 12 mm was measured and then placed across the osteotomy site giving good compression at this time and any excess bone on the dorsal aspect was resected with a bone rongeur. At this time, the wound was flushed with copious amounts of sterile saline. At this time, the 0.045 K-wire was then used to drill out the distal tip of the 2nd digit, retrograde back through the proximal phalanx and into the metatarsal. At this time, the wound was flushed with copious amounts of normal saline. The subcutaneous tissue was reapproximated utilizing 4-0 Vicryl and the skin was reapproximated utilizing 4-0 nylon.

    Attention was then directed to the 3rd digit and 3rd metatarsal where the exact same procedure was performed on the 2nd digit and 2nd metatarsal was performed on the 3rd digit and 3rd metatarsal. At this point, both wounds were cleansed in normal saline, covered with Betadine-soaked Adaptic, and covered with 4 x 4s and Kerlix. The patient's boot was applied for the patient in the OR. The patient was transferred from the OR to the PACU with vital signs stable and neurovascular status intact to all the digits of the left foot.

  2. #2
    Default
    [QUOTE=Kevinph84;99910]My Fellow Coders,

    I was wondering if one of you could help me code this case. Despite clearing CCI edits, I am concerned that still some of the CPT codes I am coming up with are still included. Any pointers will be appreciated. Thanks for your help!

    My code selections:
    28285-T1 = 735.4
    28285-T2 = 735.4
    28122-LT = 736.70
    28122-LT = 736.70
    28270-LT = 736.70
    28270-LT = 736.70


    POSTOPERATIVE DIAGNOSES:
    1. HAMMERTOE 2ND AND 3RD DIGIT, LEFT FOOT.
    2. DEFORMED METATARSALS OF 2ND AND 3RD, LEFT FOOT.

    PROCEDURES PERFORMED:
    1. ARTHROPLASTY OF DIGIT 2 AND 3, LEFT FOOT.
    2. OSTEOTOMY AND SCREW FIXATION OF METATARSALS 2 AND 3, LEFT FOOT.



    -----------------------------------------------------------------------
    Now am not an expert but i do see allot of this to know this one, how i would code that would be:

    1. 28285 T1 735.4
    2. 28285 T2, 59, 51 (cant go wrong with modifiers) i hope 735.4
    3. 28308 T1, 59, 51 736.70
    4. 28308 T2, 59, 51 736.70

    But the only problem i see is that they have to write that its a Wile Osteo not just, an Osteo. and for the other procedures that where there i dont see how that goes with the op report.

    but if am wrong i wil review this and use this as a learning experience. i havent gone to any classes my boss is teaching me as i go, and so are all the forums i read.

  3. Default
    I agree with the coding except for the modifiers for the Weil Osteotomies of the metarsals.
    The toe modifiers are only used with the phalanges, for the metatarsals
    we only use RT/LT. This information came from the Orthopedic Coding Guide for Ambulatory Surgical Centers Second Edition.


    Hope this is helpful,

    Bella

  4. #4
    Location
    New Port Richey & Gulf to Bay
    Posts
    107
    Default
    I am assuming the second set of codes? What reference resources are available for podiatry surgical coding? Thank you both for your help.

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