if doc performed an austin & akin procedure wouldn't this be a double osteotomy code 28299? doctor's office wants to bill 28306 and 28292. I'm billing for the ASC
See op note below?
DX: Hallux abductovalgus
Procedure: Austin bunionectomy w/Akin osteotomy & EHL Tendon lengthening
6cm linear longitudinal incision was made medial and parallel to the tendon of the EHL involving the contour of the deformity. incision was deepened through the subcutaneous tissue using asharp and blunt dissection. care was taken to identify and retract all vital, neuro and vascular structures. All bleeders were ligated and cauterized as necessary. at this time, an L type capsulotomy was performed over the dorsal aspect of the first MPJ and the base of the proximal phalanx. the periosteal and capsular structures were then carefully dissected free of osseous attachments and reflected medially and laterally exposing the head of the first metatarsal at the operative site next, utilizing a sagittal bone saw, the medial prominence was resected and passed from the operative field. Next a 0.045 k wire was driven from medial to lateral across the first metatarsal head to act as an access guide. Attention was directed to the medial aspect of the first metatarsal head, where a through and through V type osteotomy was created in the metaphyseal region of the bone utilizing a sagittal bone saw. The capital fragment was then shifted laterally into a more corrected position and then impacted upon the first metatarsal shaft. a 0.062 k wire was inserted across the osteotomy site for fixation. the k wire was cut and buried. attention was then directed to the remaining medial bone shaft, which was resected utilizing the sagittal bone saw and passing from the operative site. correction of the deformity was assessed at this time and noted to be good.
attention was then directed to the base of the proximal phalanx with periosteal and capsular structures reflected medially and laterally. A sagittal bone saw was used to cut to wedge from medial to lateral at the base of the proximal phalanx on maintaining to lateral cortex. the wedge of bone was then removed from the operative site. the osteotomy was then closed and fixated with 20 gauge stainless steel cerclage wire. wound was flushed with copious amounts of sterile normal saline. attention was then directed to the etenswor hallucis longus tendon, which was lengthened in a z lengthening fashion.
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