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Toe fixation I need some advise

  1. #1
    Default Toe fixation I need some advise
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    On the right second toe, I was able to ellipse out the granulomatous tissue and send for specimen to Pathology. We also removed the Trim-It pin, which was remaining, and likely causing this soft tissue irritation.

    At this point, I was able to use a rongeur, curette, and Freer to help to débride the soft tissues in the periphery of the incision site. I was then able to débride the bone as well. I was able to use a 6-2 K-wire to go from proximal to distal down the middle phalanx and distal phalanx. I then retrograded this through the proximal phalanx, and finally up into the second metatarsal head with the foot held in neutral plantar flexion.

    I really don't know what direction to go with this.

    he did fixate the toe???


  2. Default
    This is one of those times you wish for more detail. It looks like it was fixed with the k-wire but the question is - 28285 specifies only IP joint bones - the op note said the surgeon retrograded the wire (coming from the distal and middle phalynx) through the proximal phalynx up into the metatarsal head.... so if you fix the proximal phalynx to the metatarsal, (and it's NOT a hallux,) does that mean you can't use the 28285? Since it's not JUST an IP joint? That's the question I have. Since it looks like it was done to fix the IP joint, even if it was eventually anchored into the metatarsal head, I'd lean towards 28285. (And of course the possibility for an additional 20680 makes me feel rich but I don't want to add that removal if it's through the same incision as all the rest of the work...)

    I'm not much help - but those are my thoughts.


  3. #3
    dx is status post right second toe hammer toe correction with insertion of an arthrex trim it pin and granuloma formation right second toe.....

    doc wants 28043 and 28666

    What I see is the first one didn't work so well and he instead of putting the trim it pin he used a k wire for fixation of the hammertoe. so I am leaning towards 28285

    Your Thoughts????

  4. Default
    You can see where he/she is coming from - but how I see it, the 28043 is used when that's all you do - cut into the toe to remove a mass, take out the mass, sew it up, all done. Removing the granulomatous tissue is something he/she had to do in this case to 'clear the way' to get down to the bone. So I wouldn't code separately for it in this case. Then - the definition of the 28666 is to insert wires or pins through sterilized skin into the sounds like a lot more was done here....there was an incision and then excision of tissue then debridement of the bone then putting in the k-wire, etc.

    SO other than not being sure we can use the 28285 if the wire ends up in the metatarsal bone (even though it was done to fix the bones in an IP joint), I'd say 28285 is still the best choice.

    Any toe guru's out there?

  5. #5
    After talking with the Doc and the Docs office we are all in agreement that this is a 28285!!! just as I thought. Thank you for your time you were a help

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