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Thread: Excision of os trigonum surgery help

  1. #1

    Question Excision of os trigonum surgery help

    AAPC: Back to School
    New to Podiatry surgery. I am considering using 28120-59-LT 755.69 and 28119-51-LT for the following surgery. Any help is greatly appreciated! Thanks.

    1. Painful chronic plantar fasciitis, heel spur syndrome, left.

    2. Painful accessory bone, posterior aspect of the left
    subtalar joint, posterior os trigonum syndrome.

    1. Painful chronic plantar fasciitis, heel spur syndrome, left.

    2. Painful accessory bone, posterior aspect of the left
    subtalar joint, posterior os trigonum syndrome.

    1. Excision of os trigonum, posterior aspect of the left
    subtalar joint.
    2. Plantar fascial release, heel spur excision, open, left

    CLINICAL RESUME: The patient presents with chronic plantar
    fascial pain, left foot, also chronic posterior left ankle pain,
    secondary to os trigonum. The patient does wish to undergo
    surgical repair procedure. She has not responded to conservative
    measures. Surgery risks and complications explained to patient.
    No guarantees could be given.

    DESCRIPTION OF OPERATION: The patient was brought to the
    operating room and placed on the operating table in supine
    position. She was administered general inhalation anesthesia and
    local anesthetic. The left foot and ankle were prepped and draped
    in the standard sterile fashion. Tourniquet was applied to the
    thigh and the leg was elevated for 3 minutes and inflated to 325
    mmHg. Attention was then directed to the lateral left ankle. An
    approximately 4-cm was made just over the peroneal tendons
    following the fibula. The C-arm was utilized to localize the
    accessory bone or os trigonum. Dissection was then carried very
    carefully back to the posterior ankle, subtalar joint complex.
    Sural nerve and saphenous vein were retracted out of the field. A
    posterior incision was made through the ankle capsule and
    subtalar joint. The accessory bone was identified. Great care was
    taken to make sure we avoided the neurovascular structures
    medially. Flexor hallucis longus tendon was identified by flexing
    a toe. Rongeur was utilized to remove the spurring along the
    posterior aspect of the calcaneus and talus. A bone rasper was
    utilized to smooth down the bone in the joint. Verification of
    removal of the spur was done under the C-arm. Good range of
    motion of the subtalar joint and the ankle joint was noted. The
    wound was flushed copiously with normal sterile saline. Deep
    fascia layer was closed with 2-0 Vicryl in a simple interrupted
    fashion, superficial fascial layer was closed with 4-0 Vicryl in
    a simple interrupted fashion. Skin was closed with 4-0 nylon in a
    simple interrupted fashion.

    Attention was directed to the plantar medial aspect of the left
    heel. A 5-cm curvilinear incision was made along the plantar
    medial edge of the foot and angled toward the plantar fascia.
    Dissection was carried deeply distally until the plantar fascia
    was identified. Then the dissection was carried bluntly back to
    the insertional area to the heel. The plantar fascia was noted
    to be quite thickened and degenerative in appearance. It was
    resected from the plantar medial heel under direct visualization.
    A spur was then identified and removed with a rongeur and rasped
    smooth. Wound was flushed copiously with normal sterile saline.
    No other abnormalities noted in the area. The wound was closed in
    1 layer with 3-0 nylon in vertical mattress fashion and 4-0 nylon
    in a simple interrupted fashion.

  2. #2


    I would also report 28120 but since this is an accessory bone some carriers may not like 28120, then I would go unlisted

  3. #3


    Thank you Jamie!

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