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hemiphalangectomy with condylectomy?

  1. Default hemiphalangectomy with condylectomy?
    Medical Coding Books
    I'm thinking ICD9 733.99 and CPT 28160-RT for the following?

    DX: Hypertrophied lateral condyle distal phalanx first digit of right foot
    Hypertrophied lateral head proximal phalanx first digit of also right foot

    INDICATIONS FOR SURGERY:Patient is a 76‑year‑old female who presented to Surgery Center with a chief complaint of a painful exostosis of the lateral aspect of the interphalangeal joint of the first digit of the right foot.

    OPERATIVE PROCEDURE:The patient was taken to the operating room and placed on the operating room table in the usual supine manner. A pneumatic ankle tourniquet was then placed about the patient's right ankle above adequate Webril padding, but not inflated at this time. After adequate IV sedation, a total of 10 cc of 50:50 mixture of 0.5% Marcaine plain and 1% lidocaine plain was administered to the first and second digits of the right foot in a digital block technique. The right foot was then scrubbed, prepped, and draped in the usual aseptic manner. The pneumatic ankle tourniquet was then inflated to 250 mmHg after a period of elevation of the right limb. Attention was directed to the dorsolateral aspect of the first digit, where two converging semi‑elliptical incisions were made over the intraphalangeal joint of the hallux. The incision was deepened full thickness to the level of the skin and elliptical skin wedges was excised and removed the surgical field in toto. Care was taken to identify and retract all vital and neurovascular structures. The incision was depended through the subcutaneous tissues using sharp and blunt dissection. Next, a linear capsulotomy was performed over the lateral aspect of the interphalangeal joint of the hallux. The periosteum and capsules were then reflected medially and laterally exposing the lateral aspect of the interphalangeal joint. Upon adequate exposure, utilizing an oscillating saw, the hypertrophied lateral condyle of the distal phalanx was resected and removed from the operative site in toto, as well as the lateral aspect of the proximal phalanx of the hallux, which was also removed from the operative site in toto. The remaining bone of both the distal and proximal phalanx was then smoothed using a bone rasp. The incision site was then irrigated with copious amounts of normal sterile saline. The capsule and periosteum were reapproximated using 3‑0 Vicryl, subcutaneous tissues were reapproximated using 4‑0 Vicryl, and the skin was re‑approximated using 4‑0 nylon.

  2. Default
    any takers on this one?

  3. Default
    Good morning!

    I agree with CPT 28160-RT. I think your dx code would work, but the doc does state exostosis so you could use the 726.91 for bone spur.

  4. Default
    thanks for your help.

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