Vangie Posted 5 Year(s) ago
Post op dx hallux valgus left foot. Hammertoe deformities bilateral 2nd digits- bilateral 5th digits and 3rd and 4th digits left foot.
Procedure Austin bunionectomy of left foot. Proximal head resections of 2nd, 3rd, 4th and 5th digits of left foot and 2nd and 5th digits of right foot
7cm curvilinear incision was made proximal to the IP joint of the hallux. Skin and subcu structures were underscored and retracted. An inverted L shaped incision was made at the medial aspect of the capsule of the first metatarsal phalangeal joint. The capsule was underscored and retracted exposing the head of the first metatarsal. The irregular bone was removed with a power sagittal saw. A V-osteotomy was made into the first metatarsal with the apex pointing distally. The distal fragment was then moved laterally to a corrected position and fixated using cannulated screw system. screw was placed from dorsal to plantar 22 mm in length. Osteotomy was stable with good compression.
Attention to 2nd digit of left foot incision made over proximal IP joint with apex pointing distally. The incision was made into the 2nd extensor tendon at the level of the proximal IP joint. The tendon was dissected proximally. Collateral ligaments were incised exposing the head of the proximal phalanx which was removed with a power saw at the surgical neck. The identical procedure was performed on the 2nd digit o the right foot, 3rd digits of the left foot and 4th digit of the left foot.
Attention then to the 5th digit of the left foot. Incision was made over the dorsolateral aspect of the proximal IP joint. Extensor tendon was dissected proximally. Collateral ligament was incised. The head of the proximal phalanx was removed with saw at the level of the surgical neck. The identical procedure was performed on the 5th digit of the right foot.
I have codes 28296-LT, 28285-T1, 28285-T2, 28285-T3, 28285-T4, 28285-T6 and 28285-T9
SuperCoder Posted 5 Year(s) ago
Please contact Manney at 866-228-9252 Extn : 4165 Customer service
SuperCoder Posted 5 Year(s) ago
Yes, I agree fully with your code sets.
28296 qualifies here with 735.0 as Dx
28285 qualifies here with 735.4 as Dx
The physician treats a hallux valgus by surgically treating the MTP joint of the great toe by performing a Chevron osteotomy. It is also called as Austin bunionectomy. After the application of general/local anesthesia, physician makes an incision over the metatarsophalangeal joint of the foot. Further incisions are made and the small vessels are clamped and coagulated. The medial eminence is then approached with power equipment and it is removed; an osteotome and mallet can also be used to remove. In case of distal Chevron bunionectomy an osteotomy of metatarsal neck (V–shaped cut) is created through and through from medial to lateral with the apex distally. The distal capital fragment is transposed to a more normal lateral anatomic position. This is performed in order to lateralize the head. K– wire is used to stabilize. A Mitchell involves a double step cut osteotomy through the neck of the first metatarsal or in other words it involves an osteotomy made through the first metatarsal resulting to displacement of metatarsal head laterally and slightly plantarward.
When coding multiple hammertoe correction, you should submit 28285 with the appropriate modifiers for each toe.
Modifier choices: Coders often wonder whether to append modifier 59 (Distinct procedural service) or specific T modifiers (such as TA, Left foot, great toe; or T5, Right foot, great toe) for multiple hammertoe corrections. Either option should be acceptable, but know your carrier guidelines and only report one or the other, not both.
Remember: T modifiers are anatomic modifiers, and you can only report one anatomic modifier per line item. They are traditionally used for ASC or outpatient facilities and have only been approved for physician billing in recent years. Therefore, you may still have difficulty with some carriers accepting T modifiers from physicians. Check your carrier guidelines and be ready with supporting documentation if needed.
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