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hallux of rearfoot valgus right with metatarsal primus varus right foot

Vangie Posted Fri 16th of August, 2013 09:41:48 AM

Patient had post op dx of hallux of rearfoot valgus right
Metatarsal primus varus right foot

Physician performed McBride bunionectomy (modified) right foot with first metatarsal osteotomy with screw fixation.

McBride bunionectomy (modified) rt foot attention to 1st metatarsal curvilinear incision medial to the extensor hallcis longus tendon. A capsule and periosteal incision was made. The medial and lateral collateral ligaments were incised and the head of the first metatarsal was delivered to the operative site. Utilizing sagittal saw the dorsal medial eminence was resected flush with the dorsal medial eminence wage resected flush with the medial aspect of the shaft of the first metatarsal. A lateral release was performed via the first interspace. Incision was then deepened. A transverse capsule incision was placed overlying the fibular sesamoid. The fibular sesamoid was showed to be in the interspace and freed distally, proximally and plantarly making sure to preserve the flexor apparatus. A contracture remained of the lateral aspect of the first MPJ. Therefore the lateral head of the abductor was then resected en toto. Joint contracture remained. Therefore the extensor halluces brevis tendon was released. At that time the lateral release was shown to replace the sesamoids underneath the first metatarsal head with compression at the IM angle showing adequate lateral release.

First metatarsal osteotomy with screw fixation right foot at this time, attention was then directed to the medial aspect of the first metatarsal using 0.45 K wire as an osteotomy guide was placed dorsal to the mid center of the first metatarsal head and was fashioned approximately 1 cm proximal to the articular cartilage. A through and through osteotomy was placed on the plantar arm of the osteotomy site and this was through and through. At this time the osteo guide was then positioned in a more dorsal direction at approximately 70 to 75 degrees from the access guide creating a Chevron type osteotomy.

Next the dorsal arm of the osteotomy was from a medial to lateral direction. This was done through and through. The excess guide was removed. Next the leg and osteotome and all remaining areas were freed. At this time the head of the first metatarsal was shifted laterally approximately 1/4 of the width of the first metatarsal. Next utilizing 045 K wire was introduced across the osteotomy site to prove temporary fixation prior to application of the cancellous screw. Utilizing the AO technique a 4.0 bunionectomy screw with a 2-7 head was then systematically inserted across the osteotomy site. Next utilizing a sagittal saw the remaining bony prominence on the medial aspect was dissected en toto and burned smooth. At this time utilizing evaluation it was determined at the Akin osteotomy would not be performed due to adequate correction and the osteotomy and soft tissue release.

I used 28292-T5 but don't feel this captures all the work performed.

SuperCoder Answered Fri 16th of August, 2013 19:34:12 PM

Hi,

Please contact Manney at 866-228-9252 Extn : 4165 Customer service

SuperCoder Answered Tue 20th of August, 2013 17:49:21 PM

"Akin osteotomy would not be performed due to adequate correction " rules out 28299 .

You will need to code 28296-RT here with 735.0 as Dx

The McBride procedure says : The physician performs the transfer or release of adductor hallucis tendon and capsulotomy on the lateral side of MTP. A medical capsular imbrications or advancement is also performed to treat the hallux. But the lateral sesamoid is not removed/ released. Once done the medial eminence of metatarsal eminence is resected.

28292 and 28296 as described by "Modified" McBridge and Chevron Osteotomy for Hallux Valgus correction. These are considered bundled codes.

You will need to code only 28296 here to capture the scenario described above.

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