05/08/2017

Coding for Long Arm Chevron Osteotomy, Removal of Osteophytes on Base of Proximal Phlanax and Head of First Metatarsal Along with a Cartiva Implant Placed into a Osteochondral Defect of First Metatars

A patient presents with a hallux limitis/valgus condition. The doctor performs a long arm chevron osteotomy, removal of osteophytes on both the base of the proximal phalanx and head of the first metatarsal, and a cartiva implant was placed into an osteochondral defect of the head of the first metatarsal. What is the correct way to code for this?

You may bill a 28291 with CPT 28124 with modifier 59.

28291- Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant

Lay Description Code

The physician corrects a hallux rigidus deformity and performs a cheilectomy. Hallux rigidus is a condition caused by degenerative (DJD) arthritic changes at the first metatarsophalangeal joint, causing pain, limited range of motion, and dorsiflexion. In the context of this procedure, a cheilectomy refers to excision of part of the lip of the first metatarsophalangeal joint. The podiatrist makes a dorsal incision over the first metatarsophalangeal joint. The extensor hallucis longus tendon is retracted and the joint capsule is entered. Osteophytes and part of the metatarsal head are excised. Bony irregularities may be removed using a chisel and edges smoothed with a rasp. When adequate dorsiflexion (60 to 80 degrees) is obtained, the capsule is closed, the tendon is returned to its correct anatomical position, and the skin is closed with sutures. Report 28291 when the procedure includes an implant.

28194- Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe

Lay Description Code

The physician performs a partial excision of the talus or calcaneus in 28120, a tarsal or metatarsal bone in 28122, or the phalanx of a toe in 28124 to remove infected bone or bony prominence. An incision is made over the affected part of the foot, ankle, heel, or toe and the underlying soft tissues are divided to expose the bone. The periosteum is reflected and the infected portion of bone is removed and irrigated. The excavation of bone may excise a crater-like piece, leave a small saucer-like shelf depression in the bone, or may remove a portion of the shaft (diaphysis) of a long bone. If a significant portion of bone is removed, the physician may use bone graft material to fill the cavity left in the bone. The periosteum is closed over the bone, the soft tissues are sutured closed, and a soft dressing is applied. A short leg cast may be applied to keep the foot and ankle in position.

Modifier 59: Distinct procedural service

Usage: This modifier is allowable for radiology services. It may also be used with surgical or medical codes in appropriate circumstances. When billing, report the first code without a modifier. On subsequent lines, report the code with the modifier.

Definition: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non E/M service performed on the dame date, see modifier 25.