Hi,

I'm new to podiatry coding and need help with the CPT codes for this OP report. How do I determine which are the correct codes for these procedures? Thanks so much.

PREOPERATIVE DIAGNOSIS: Tailor's bunion right foot, hammertoe second right foot.

POSTOPERATIVE DIAGNOSIS: Tailor's bunion right foot, hammertoe second right foot.

PROCEDURE: Osteotomy fifth metatarsal right foot, osteotomy second metatarsal right foot, arthroplasty proximal interphalangeal joint second toe right foot.


OPERATION FINDINGS: The patient was taken to the operating room and placed in supine position on the operating table. IV sedation was provided by anesthesia and the foot was blocked with Xylocaine 2% and Marcaine 0.5%. She was prepped and draped in the usual manner. Following prepping and draping, an approximate 4 cm incision was made over the dorsolateral aspect of the right foot over the fifth metatarsal head and neck. This was deemed to sharp and blunt dissection. Venous structures being bovied or ligated as indicated. At the neck of the fifth metatarsal, an oblique osteotomy was performed extending from dorsal to plantar and from distal lateral to proximal medial. Head was separated from the shaft and relocated more medially. Utilizing cannulated screw technique an OrthoPro 2.5 mm screw is placed across the osteotomy site. The bone was somewhat soft and shattered and fixation was ultimately achieved with an 062 threaded pin. No motion was noted at the osteotomy site and good fixation was apparent. Site was flushed with copious amounts of 10% Betadine solution before and after fixation. The tailor's bunion was now gone and osteotomy was tight
and the deep structures were closed with 4-0 Vicryl and the skin with 4-0 nylon. Attention was then directed over the dorsum of the right foot over the second metatarsal distally where a 4 cm incision was made over the head and neck. Deemed with sharp and blunt dissection again, venous structures being bovied or ligated as indicated. An oblique osteotomy was performed at the neck of the second metatarsal extending from dorsal distal to plantar proximal and the head was separated from the shaft. A 3 mm wafer of bone was removed at the osteotomy site, thereby shortening the second metatarsal. Utilizing cannulated screw technique an OrthoPro 2.5 mm screw was placed across the osteotomy site. It was 26 mm in length. It was cinched up tight and no motion was noted at the osteotomy site and the head was tightly fixated to the shaft. Site was flushed with 10% Betadine solution before and after fixation. Deep structures closed with 4-0 Vicryl and the skin with 4-0 nylon. The second toe was now noted to be in a more normal position and the flexure transfer was no longer indicated. However, the toe still did have a medial deviation at the proximal interphalangeal joint and the medial deviation at the neck of the proximal phalanx was evident on x-ray. A proximal interphalangeal arthroplasty was then completed with the head being resected from the shaft. An ellipse of skin was removed from the lateral aspect of the toe at the level of the proximal interphalangeal joint thereby facilitating straightening of the second toe. Site was again flushed with 10% Betadine solution and the skin closed with 4-0 nylon. The surgical sites were all dressed with Betadine soaked Adaptic, sterile 4 x 4s, 2 inch Kling, and an Ace wrap. Patient tolerated the procedure well and was returned to recovery in apparent satisfactory condition.