Physician marked both codes for the 2nd and 3rd metatarsals; I feel like it should be 28122, but I could be wrong. Any feedback would be appreciated...


INDICATIONS: This patient was seen in the Wound Center with a nonhealing ulcer. X-rays were obtained and it was noted that she had significant deformities to both feet by per prior surgeon. The metatarsal heads were resected on all metatarsal heads and she had a nonhealing ulcer in the plantar aspect of her left foot. Neurological sensations were also diminished in a stocking type distribution from the midfoot distally only on the left foot. The patient was informed that this may be one of many procedures she will need in the future and she will mostly likely have severe disfigurement of the foot because of the loss of bone.

DESCRIPTION OF PROCEDURE: The patient was placed in the supine position on the OR table. Anesthesia was not needed. A pneumatic ankle tourniquet was inflated to 250 mmHg. Attention was directed to the fifth digit on the left foot after the foot was prepped and draped in a sterile technique. A 3 cm incision was made over the proximal interphalangeal joint. The skin incision was deepened. Subcutaneous tissue was underscored and retracted. A transverse incision was made through the extensor apparatus and reflected proximally. The head of the proximal phalanx was then resected. The wound was copiously flushed with sterile saline and sponge dry. The extensor tendon was then re-approximated with 4-0 Vicryl and skin margins were re-approximated with 5-0 nylon. It was noted that the fifth digit was now in anatomically correct position and was no longer plantar flexed. Attention was then directed to the second metatarsal where a 4-6 cm incision was made over the third metatarsal. Skin incision was deepened by means of sharp dissection. Subcutaneous tissue was underscored and retracted. A capsular tissue was then made extending the length of the initial skin incision. It was noted that the articular head of the third metatarsal was gone and there was a large plantar spur noted. This was directly over the plantar ulcer. The head of the third metatarsal had to be resected at the surgical neck. Attention was then directed to the second metatarsal where the second metatarsal was identified and also it was noted that the head of the second metatarsal was resected, and there were some small bony spicules noted. This was then resected with a bone nipper and a rasp. The wound was copiously flushed with sterile saline and sponge dry.
Attention was then directed to the subcutaneous tissue where it was re-approximated with 4-0 Vicryl and skin margins were then re-approximated with 5-0 nylon. Attention was directed then plantarly to the ulcer. The ulcer was then debrided sharply with a #15-blade. Good bleeding was noted. At this time, all surgical areas were then dressed with Xeroform, 4x4s, and a wrap. The patient tolerated the procedure and anesthesia without incident, and left the operating room for the dressing room with vital signs stable. This patient will be followed up in the Diabetic Center.


Thanks