AHA Coding Clinic® for HCPCS - 2021 Issue 1; For Your Information
Metatarsophalangeal joint and plantar plate repair
A patient presented with a left ruptured plantar plate, dorsal contracture with subluxation and ruptured flexor tendons of the second metatarsophalangeal joint. Both dorsal and plantar incisions were made over the second metatarsophalangeal joint. Through the dorsal incision, a capsulotomy was made and previously placed hardware was removed. Through the plantar incision, drill holes were created in preparation for the plantar plate repair with an InternalBrace™ and the use of Arthrex screws. Once the Fiber tape and anchors were placed, the flexor tendons were repaired by suturing the tendons into the distal portion of the repaired plantar plate at the base of the proximal phalanx. GraftJacket dermal allograft was placed from dorsal to plantar to over lay the degenerative second metatarsal head. It was then sutured into the plantar joint capsule and plantar plate correcting the metatarsophalangeal joint subluxation. Is it appropriate to assign CPT codes 28645 and 28899 for dorsal subluxation repair of the metatarsophalangeal joint with internal brace and plantar plate repair with graft jacket? ...
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Article Overview
This premium article reviews a foot and ankle surgical case centered on repair of the second metatarsophalangeal joint. It covers the operative approach, the structures addressed, and the materials used during reconstruction, while also raising the coding question of whether CPT reporting is appropriate for the encounter. The content is useful for coders, auditors, and clinicians who need to understand how the operative details fit within procedural coding considerations.
Why This Topic Matters
Procedures on the metatarsophalangeal joint can involve multiple anatomic structures and operative steps, making documentation review important for accurate procedural classification. This article helps readers assess the scope of the surgery and the relevant coding framework at a high level.
What You Will Learn
- The operative structures involved in a second metatarsophalangeal joint repair
- How tendon, joint capsule, and plantar plate repair are described in a surgical note
- What types of implant and graft materials may be mentioned in this kind of case
- Why the documentation raises a CPT coding question
Who Should Read This
- Medical coders
- Coding auditors
- Podiatry billing staff
- Orthopedic surgery staff
- Revenue cycle professionals
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