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Is K wire included in 28285????

  1. #1
    Talking Is K wire included in 28285????
    Medical Coding Books
    Wondering if someone can help me.

    Here are the codes I've selected but per coder's desk reference does not state anything to do with K wire. Is K wire included in 28285? Plus do my codes look about right?
    Please and thank you for any help.

    28292-LT 735.0
    28285-59-T1, 735.0
    28295-59-T2, 735.0
    28295-59-T3, 735.0


    POSTOPERATIVE DIAGNOSES: Hallux valgus left foot, hammer toe deformities
    second, third and fourth toes all of the left foot.

    PROCEDURE:
    1. McBride bunionectomy left foot.
    2. Hammer toe correction second, third and fourth toes of the left foot.


    OPERATIVE TECHNIQUE: The patient was brought to the operating room and
    placed on the operating room table in the supine position with an IV
    intact for intravenous sedation. The patient was given 2 grams of Kefzol
    for routine orthopedic prophylaxis. The left foot was prepped and
    draped in the usual aseptic manner and then exsanguinated with an
    Esmarch bandage. Hemostasis was maintained with an ankle pneumatic
    tourniquet inflated to 250 mmHg.

    Attention was directed to the dorsal aspect of the left foot where an
    approximately 5 cm linear skin incision was performed just medial to the
    extensor hallucis longus tendon. The incision was deepened down through
    subcutaneous tissue, taking care to coagulate venules and retract
    neurovascular structures. A linear capsule and periosteal incision was
    performed and the capsular and periosteal tissue reflected from the
    medial aspect of the first metatarsal head exposing hyperostosis into
    the surgical site. The hyperostosis was resected with the sagittal saw,
    taking care to protect the sagittal root plantarly. Attention was then
    directed to the first interspace where dissection was carried out down
    to the level of the fibular sesamoidal bulge. The fibular sesamoid was
    identified and then freed on all sides until erectus position of the
    great toe, allowed the sesamoid to glide back beneath the metatarsal
    head. All remaining adductor tendon fibers were also transected at that
    time. The site was irrigated with copious amounts of sterile normal
    saline. All bony edges were smoothed. The capsular tissue was
    reapproximated with 2-0 and 3-0 Vicryl sutures, subcutaneous tissue with
    4-0 Vicryl suture and the skin incision with 5-0 Vicryl subcuticular
    suture.

    Attention was then directed to the second toe, identical procedures were
    performed on the second, third and fourth digits.

    The 2 converging elliptical incisions were performed over the proximal
    interphalangeal joint. The intervening skin was excised in toto. The
    incision was deepened down to the extensor tendon. Care was taken to
    retract neurovascular bundles on each side. A transverse tenotomy and
    capsulotomy was performed at the proximal interphalangeal joint. The
    head of the proximal phalanx was resected in a Chevron type fashion, as
    well as resection of the base of the middle phalanx. The toe remained
    contracted at the metatarsal phalangeal joint, thus an extensor hood
    release was performed as well as dorsal medial and lateral capsulotomies
    at that level. This allowed the toe to sit in a rectus position. A K-
    wire was integrated out the tip of the toe, and then retrograded back
    across the proximal interphalangeal joint to the metatarsal phalangeal
    joint level.
    The extensor tendon was reapproximated with 4-0 Vicryl
    sutures, subcutaneous tissue with 4-0 Vicryl suture and the skin was
    closed with 5-0 Vicryl subcuticular suture.

  2. #2
    Default
    Yes, the K wire is inclusive in the Hammertoe repair. The K-wire stabilizes the repair and removal will be inclusive in procedure. I agree with your code choices. Dx codes: Hammertoe vs HV I use 735.4 for hammertoe unless physician notes some congential issue. But I'd like to have a 2nd opinion.

  3. #3
    Default
    We never bill for K wire or any screws/pins its always included in the procedure.

  4. #4
    Default
    Thank you for the help.

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