Fellow Podiatry Coders!
I am having a hard time coding for the Weil osteotomy and plantar plate. I am getting closer but I think we could increase reimbursement if I used modifiers more efectively.
Thank you for your help!!
Denise
POSTOPERATIVE DIAGNOSES:
1. Right foot bunion deformity.
2. Right foot second metatarsophalangeal joint contracture with plantar
plate tear.
OPERATION PERFORMED:
1. Austin-Akin bunionectomy on the right foot.
2. Right foot Weil osteotomy of the second metatarsal with plantar plate
repair.
RIGHT FOOT AUSTIN-AKIN BUNIONECTOMY: Utilizing a sterile skin marker, a
roughly 5 to 6 cm surgical incision was planned about the dorsomedial
aspect of the right first ray. After plane of the incision, the skin blade
was utilized in order to incise through the skin until fatty underlying
subcutaneous tissue was visualized. Any vessels crossing the operative
site was then coagulated utilizing Bovie. A deep blade was then used to
carry dissection through the subcutaneous tissue to the level of the joint
capsule. A residence's notch was started medial to the first met head and
starting a dissection layer which was continued utilizing a curved
Metzenbaum scissor. Once this was achieved, a longitudinal capsular
periosteal incision was made the full length of the incision. As the #15
blade was carried across the first MPJ, the hallux was dorsiflexed in order
to protect the articular cartilage of the first metatarsal head. A #15
blade was then utilized in order to free capsule and periosteal tissues
both medially and laterally around the first metatarsal head in order to
achieve adequate surgical exposure. Once this was done, retraction was
held by an assistant. A 0.045 K-wire was then drilled with inside the
central metaphyseal region of the first metatarsal head and orientation was
checked. The guidewire was placed in the orientation that would just allow
slight plantar flexion of the capital fragment once lateral shift was
achieved. After position of the guidewire was deemed adequate, the
osteotomy guide was then placed over the 0.045 K-wire and the Austin
osteotomy was conducted in standard fashion utilizing oscillating saw and
medium blade. Once this was done, the guidewire was then removed, the first
metatarsal head was laterally transposed and held in place, a guidewire for
the Stryker Asnis screw set was then placed in order for final screw
fixation. Finally, one 3.0 x 18 mm Stryker micro Asnis screw was inserted
across the osteotomy site. The fixation was found to be firm and adequate.
Attention was then turned to the base of the hallux proximal phalanx where
retraction was held both medially and laterally along the proximal phalanx,
allowing exposure of the base. Oscillating saw was then utilized in order
to execute the medial base wedge Akin osteotomy. Once the Akin osteotomy
was completed, the area was then prepped on either side of the osteotomy by
drilling for final fixation of one Stryker EasyClip size 8 staple, one
Stryker EasyClip 8 staple was then tamped firmly into place, allowing a
rectus position of the hallux. This operative site was then flushed with
copious amounts of sterile saline. Prior to closure, a medial
capsulorrhaphy was performed in order to obtain further capsular correction
of the hallux valgus deformity. Capsular tissue was then closed with 3-0
Vicryl sutures in a simple interrupted technique followed by subcuticular
closure with 4-0 Vicryl suture interrupted technique. Skin was then closed
with 4-0 nylon suture in a simple interrupted technique.
RIGHT SECOND METATARSAL WEIL OSTEOTOMY WITH PLANTAR PLATE REPAIR: A
roughly 4 cm surgical incision was planned in a longitudinal fashion from
the neck of the second metatarsal onto the base of the second digit
proximal phalanx. The skin was then incised with a #15 blade until fatty
underlying subcutaneous tissue was visualized. Once this was done, any
vessels crossed the operative site was coagulated utilizing the Bovie.
Blunt dissection was carried down to the level of deep fascia where the
long extensor tendon and _____ joining brevis tendon were visualized. A
deep #15 blade was then used in order to split the 2 tendon's directly
overlying the second metatarsal and base of the second digit proximal
phalanx. Capsular or periosteal tissues were both reflected from the joint
sharply with a #15 blade. A Weitlaner retractor was then inserted for
operative visualization. The second digit was then forcibly plantarflexed
and capsular tissues were released from the head of the second metatarsal
utilizing the McGlamry elevator. At this point, the oscillating saw was
then used with the second digit plantar flexed to perform the Weil
osteotomy. After conduction of the Weil osteotomy of the second
metatarsal, the capital fragment of the head of the second metatarsal was
retracted easily. With a 0.062 K-wire and wire driver, the capital
fragment of the second metatarsal head was then fixated in place. A second
0.062 K-wire was then drilled within the shaft of the second digit proximal
phalanx. Hintermann joint distraction was placed overlying the 0.062
K-wires and the joint was distracted allowing adequate visualization with
inside of the joint. It is of note that the second metatarsophalangeal
joint plantar plate was damaged with a small tear noted medially and along
the base of the second digit proximal phalanx. With a 64 blade, the
plantar plate was then section completely close to the base of the second
digit proximal phalanx. Once this was done utilizing the scorpion
instrumentation from the Arthrex set, one suture strands of 0 FiberWire was
threaded through the plantar plate at its medial and lateral aspects. Once
this was done, guide holes were then placed utilizing the 0.062 K-wire in
the base of the second digit proximal phalanx, both medially and laterally.
The strand of 0 FiberWire was then threaded through each of these drill
holes from plantar to dorsal. Once this was done, the 0 guidewire 0.8 x
0.062 K-wire was then removed from the second metatarsal. The second
metatarsal head was reset and then fixated with 2 size 12 mm Arthrex
snap-off screws. Fixation was confirmed and adequate. Once the Weil
osteotomy was fixated, the second digit was forcibly plantarflexed and the
0 FiberWire suture was hand tied into place along the second digit to sit
in a rectus plantarflexed position. The operative site was then flushed
with copious amounts of sterile saline. Capsular tissues were then closed
with 3-0 Vicryl sutures and subcuticular closure with 4-0 Vicryl suture in
interrupted technique followed by 4-0 nylon suture for skin with a simple
interrupted technique.
I am having a hard time coding for the Weil osteotomy and plantar plate. I am getting closer but I think we could increase reimbursement if I used modifiers more efectively.
Thank you for your help!!
Denise
POSTOPERATIVE DIAGNOSES:
1. Right foot bunion deformity.
2. Right foot second metatarsophalangeal joint contracture with plantar
plate tear.
OPERATION PERFORMED:
1. Austin-Akin bunionectomy on the right foot.
2. Right foot Weil osteotomy of the second metatarsal with plantar plate
repair.
RIGHT FOOT AUSTIN-AKIN BUNIONECTOMY: Utilizing a sterile skin marker, a
roughly 5 to 6 cm surgical incision was planned about the dorsomedial
aspect of the right first ray. After plane of the incision, the skin blade
was utilized in order to incise through the skin until fatty underlying
subcutaneous tissue was visualized. Any vessels crossing the operative
site was then coagulated utilizing Bovie. A deep blade was then used to
carry dissection through the subcutaneous tissue to the level of the joint
capsule. A residence's notch was started medial to the first met head and
starting a dissection layer which was continued utilizing a curved
Metzenbaum scissor. Once this was achieved, a longitudinal capsular
periosteal incision was made the full length of the incision. As the #15
blade was carried across the first MPJ, the hallux was dorsiflexed in order
to protect the articular cartilage of the first metatarsal head. A #15
blade was then utilized in order to free capsule and periosteal tissues
both medially and laterally around the first metatarsal head in order to
achieve adequate surgical exposure. Once this was done, retraction was
held by an assistant. A 0.045 K-wire was then drilled with inside the
central metaphyseal region of the first metatarsal head and orientation was
checked. The guidewire was placed in the orientation that would just allow
slight plantar flexion of the capital fragment once lateral shift was
achieved. After position of the guidewire was deemed adequate, the
osteotomy guide was then placed over the 0.045 K-wire and the Austin
osteotomy was conducted in standard fashion utilizing oscillating saw and
medium blade. Once this was done, the guidewire was then removed, the first
metatarsal head was laterally transposed and held in place, a guidewire for
the Stryker Asnis screw set was then placed in order for final screw
fixation. Finally, one 3.0 x 18 mm Stryker micro Asnis screw was inserted
across the osteotomy site. The fixation was found to be firm and adequate.
Attention was then turned to the base of the hallux proximal phalanx where
retraction was held both medially and laterally along the proximal phalanx,
allowing exposure of the base. Oscillating saw was then utilized in order
to execute the medial base wedge Akin osteotomy. Once the Akin osteotomy
was completed, the area was then prepped on either side of the osteotomy by
drilling for final fixation of one Stryker EasyClip size 8 staple, one
Stryker EasyClip 8 staple was then tamped firmly into place, allowing a
rectus position of the hallux. This operative site was then flushed with
copious amounts of sterile saline. Prior to closure, a medial
capsulorrhaphy was performed in order to obtain further capsular correction
of the hallux valgus deformity. Capsular tissue was then closed with 3-0
Vicryl sutures in a simple interrupted technique followed by subcuticular
closure with 4-0 Vicryl suture interrupted technique. Skin was then closed
with 4-0 nylon suture in a simple interrupted technique.
RIGHT SECOND METATARSAL WEIL OSTEOTOMY WITH PLANTAR PLATE REPAIR: A
roughly 4 cm surgical incision was planned in a longitudinal fashion from
the neck of the second metatarsal onto the base of the second digit
proximal phalanx. The skin was then incised with a #15 blade until fatty
underlying subcutaneous tissue was visualized. Once this was done, any
vessels crossed the operative site was coagulated utilizing the Bovie.
Blunt dissection was carried down to the level of deep fascia where the
long extensor tendon and _____ joining brevis tendon were visualized. A
deep #15 blade was then used in order to split the 2 tendon's directly
overlying the second metatarsal and base of the second digit proximal
phalanx. Capsular or periosteal tissues were both reflected from the joint
sharply with a #15 blade. A Weitlaner retractor was then inserted for
operative visualization. The second digit was then forcibly plantarflexed
and capsular tissues were released from the head of the second metatarsal
utilizing the McGlamry elevator. At this point, the oscillating saw was
then used with the second digit plantar flexed to perform the Weil
osteotomy. After conduction of the Weil osteotomy of the second
metatarsal, the capital fragment of the head of the second metatarsal was
retracted easily. With a 0.062 K-wire and wire driver, the capital
fragment of the second metatarsal head was then fixated in place. A second
0.062 K-wire was then drilled within the shaft of the second digit proximal
phalanx. Hintermann joint distraction was placed overlying the 0.062
K-wires and the joint was distracted allowing adequate visualization with
inside of the joint. It is of note that the second metatarsophalangeal
joint plantar plate was damaged with a small tear noted medially and along
the base of the second digit proximal phalanx. With a 64 blade, the
plantar plate was then section completely close to the base of the second
digit proximal phalanx. Once this was done utilizing the scorpion
instrumentation from the Arthrex set, one suture strands of 0 FiberWire was
threaded through the plantar plate at its medial and lateral aspects. Once
this was done, guide holes were then placed utilizing the 0.062 K-wire in
the base of the second digit proximal phalanx, both medially and laterally.
The strand of 0 FiberWire was then threaded through each of these drill
holes from plantar to dorsal. Once this was done, the 0 guidewire 0.8 x
0.062 K-wire was then removed from the second metatarsal. The second
metatarsal head was reset and then fixated with 2 size 12 mm Arthrex
snap-off screws. Fixation was confirmed and adequate. Once the Weil
osteotomy was fixated, the second digit was forcibly plantarflexed and the
0 FiberWire suture was hand tied into place along the second digit to sit
in a rectus plantarflexed position. The operative site was then flushed
with copious amounts of sterile saline. Capsular tissues were then closed
with 3-0 Vicryl sutures and subcuticular closure with 4-0 Vicryl suture in
interrupted technique followed by 4-0 nylon suture for skin with a simple
interrupted technique.
Weil Osteotomy and Plantar Plate
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