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Bunion correction

  1. #1
    Fort Worth Texas
    Question Bunion correction
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    I'm rather new to this specialty and still trying to wrap my brain around it I'm hoping someone can help explain the coding on the below scenerio. My thought process is under the op note.

    The contracted lateral capsule between the fibular sesamoid and the first metatarsal head and proximal phalanx was incised. The common adductor tendon inseltion was released including the metatarsal sesamoid ligament. This series of maneuvers relieved the contracted lateral soft tissues. The toe could be easily manipulated and positioned at this point.

    A separate medial skin incision was made from the base of the proximal phalanx to the base of thefirst metatarsal. Careful dissection continued down through the skin and subcutaneous tissues. Care was taken to avoid the dorsal and plantar sensory nerve branches. Longitudinal capsulotomy was done at the first MTP joint. The hypeltrophic bursa was excised. The medial eminencewas exposed and was resected in line with the metatarsal shaft proximally. There was just a little bit of joint degeneration which had occuned on the dorsal lateral aspect of the first metatarsal head and a little bit of wear at the metatarsal sesamoid alticulation but this wasn't too bad. The base of the first metatarsal was exposed in an extra periosteal fashion. A mau osteotomy was done with a short plantar limb and a long dorsal limb extending distally. The capital fragment was then rotated laterally and the osteotomy was secured with a bone clamp. The position of the toe was excellent clinically and radiographically. The osteotomy was securedwith two 2.4 rom fully threaded bicOlticallag screws from dorsal to plantar. I was well satisfied with the correction.

    Would this be coded as 28296 and 28292-59 since their are seperate inscions (lateral and medial)? My understanding is you can not use two bunionectomy codes on the same foot. That leads me to 28299 but I do not see that two osteotomies were done. The lateral incision was for a soft tissue correction. The medial was for the osteotomy. Is this just a 28296 and the soft tissue correction is included even though two seperate incisions occured?

    I appreciate any input given! Thanks for your time.


  2. #2
    I would only use the 28299 if 2 osteotomies were done, like bone cut on metatarsal and phalanx.
    The other procedure sounds more like capsulotomy (28270) but since it is same toe as bunionectomy, it is included, its listed as separate procedure.

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