Hello fellow coders! I am not a very good coder when it comes to feet. I would like some help in coding this op note. I was thinking 28299 but when he said a Modified McBride was done, I don't know if I just need to code the Modified McBride? Any help will be greatly appreciated. Thanks in advance for any help provided!!!
PROCEDURES PERFORMED:
1. Correction of bunion first metatarsophalangeal joint, left.
2. Correction of hammertoe second.
3. Correction of hammertoe third
The patient was identified and placed on the treatment table in the supine
position. Following general endotracheal intubation, the left foot was scrubbed, prepped and draped in
usual aseptic manner. 50 cc of Bupivacaine/Ketorolac infiltrated in the foot and ankle for pre and
postoperative block. Linear incision was placed medial and parallel to the EHL tendon on the first
metatarsophalangeal joint. Deeper incision made distal to the hallux down the periosteal incision was
made and Akin osteotomy was completed. The wafer of bone on the medial aspect of the proximal
phalanx was removed. Rotation of the hallux was completed with stabilization with #8 mm staple from
Medline. It was subcu to the medial portion of first metatarsal subcapsular where the medial prominence
was resected without complication. Capsular tightening was performed with 2-0 FiberWire in retention of
the capsule medially, closed with 2-0 Vicryl and 3-0 Vicryl subcu and then skin closed with 4-0 nylon.
Modified McBride bunion was corrected and the lateral release was completed. An incision was made
through the next procedure. At this point, we did a linear incision over dorsal second toe. Blunt dissection
carried down to the second MTP and release of the second MTP was performed. The toe floated in a
more corrected anatomic alignment. Gentle dissection was then performed into the inner space where the
adductor tendon was addressed from bunion procedure. The lateral portion of the fibular sesamoid was
released of the adductor as well as the portion to the distal phalanx. At this point, relaxation of the
adductor was completed. We then addressed the PIP joint which was transverse tenotomy and
capsulotomy for the second toe. The head of the proximal phalanx and base of the intermediate phalanx
was resected. K-wire was then utilized exiting the distal aspect of the toe retrograded proximal across the
PIPJ into the second metatarsal for retention and good alignment noted. At this time, we also went to the
third metatarsophalangeal joint where release of the capsular structures in the extensor as low as the
flexor was completed to correct the hammertoe left third toe. It was performed without complications
through the second incision for the surgery. We then addressed the second digit with a cannulated digital
arthrodesis screw with primary wire placement. We irrigated with normal sterile saline. We closed after
screw placement periosteal layer with 2-0 Vicryl, subcutaneous stitch with 3-0 Vicryl, skin closed with 4-0
nylon. Wire was retained for position purposes. It was bent and cut at the distal aspect of the toe. Again
skin was closed with 4-0 nylon on the second MTP and distal portion of second toe. Following completion
of procedure, Xeroform, 4x4s, Kerlix, Ace bandage were applied. The patient tolerated the procedure and
was transferred out of the treatment room with vital signs stable and vascular status intact.
PROCEDURES PERFORMED:
1. Correction of bunion first metatarsophalangeal joint, left.
2. Correction of hammertoe second.
3. Correction of hammertoe third
The patient was identified and placed on the treatment table in the supine
position. Following general endotracheal intubation, the left foot was scrubbed, prepped and draped in
usual aseptic manner. 50 cc of Bupivacaine/Ketorolac infiltrated in the foot and ankle for pre and
postoperative block. Linear incision was placed medial and parallel to the EHL tendon on the first
metatarsophalangeal joint. Deeper incision made distal to the hallux down the periosteal incision was
made and Akin osteotomy was completed. The wafer of bone on the medial aspect of the proximal
phalanx was removed. Rotation of the hallux was completed with stabilization with #8 mm staple from
Medline. It was subcu to the medial portion of first metatarsal subcapsular where the medial prominence
was resected without complication. Capsular tightening was performed with 2-0 FiberWire in retention of
the capsule medially, closed with 2-0 Vicryl and 3-0 Vicryl subcu and then skin closed with 4-0 nylon.
Modified McBride bunion was corrected and the lateral release was completed. An incision was made
through the next procedure. At this point, we did a linear incision over dorsal second toe. Blunt dissection
carried down to the second MTP and release of the second MTP was performed. The toe floated in a
more corrected anatomic alignment. Gentle dissection was then performed into the inner space where the
adductor tendon was addressed from bunion procedure. The lateral portion of the fibular sesamoid was
released of the adductor as well as the portion to the distal phalanx. At this point, relaxation of the
adductor was completed. We then addressed the PIP joint which was transverse tenotomy and
capsulotomy for the second toe. The head of the proximal phalanx and base of the intermediate phalanx
was resected. K-wire was then utilized exiting the distal aspect of the toe retrograded proximal across the
PIPJ into the second metatarsal for retention and good alignment noted. At this time, we also went to the
third metatarsophalangeal joint where release of the capsular structures in the extensor as low as the
flexor was completed to correct the hammertoe left third toe. It was performed without complications
through the second incision for the surgery. We then addressed the second digit with a cannulated digital
arthrodesis screw with primary wire placement. We irrigated with normal sterile saline. We closed after
screw placement periosteal layer with 2-0 Vicryl, subcutaneous stitch with 3-0 Vicryl, skin closed with 4-0
nylon. Wire was retained for position purposes. It was bent and cut at the distal aspect of the toe. Again
skin was closed with 4-0 nylon on the second MTP and distal portion of second toe. Following completion
of procedure, Xeroform, 4x4s, Kerlix, Ace bandage were applied. The patient tolerated the procedure and
was transferred out of the treatment room with vital signs stable and vascular status intact.