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March 24, 2015
Test your coding knowledge with this scenario about coding plantarflexed third right metatarsal with... Learn More

March 13, 2015
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February 19, 2015
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Code This!

Current Scenario Week of March 24, 2015:
View Answer From Last Scenario

Assign the correct ICD-9-CM and ICD-10-CM diagnosis and PCS procedure codes for the following outpatient coding scenario:

HISTORY AND PHYSICAL
HISTORY OF PRESENT ILLNESS: 68 y/o female for podiatric surgery for plantarflexed third metatarsal due to idiopathic metatarsal joint osteoarthritis

PAST MEDICAL HISTORY: Non-contributory

SOCIAL HISTORY: Non-contributory

ALLERGIES: NKDA

PHYSICAL EXAMINATION:
HEENT: WNL
Back: No spinal or renal tenderness
Skin: Fair with multiple lesions (patient followed by dermatologist)
Lungs: Clear to auscultation and percussion
Heart: Regular rate and rhythm, no murmurs
Abdomen: Benign
Pelvic/Rectal: Deferred
Neurologic: Intact
Musculoskeletal: Intractable plantar keratosis, third right metatarsal

OPERATIVE REPORT
PRE-OPERATIVE DIAGNOSIS: Plantarflexed third right metatarsal with resulting intractable plantar keratosis, third right metatarsal head

POST-OPERATIVE DIAGNOSIS: Same

PROCEDURE: Distal oblique osteotomy, third right metatarsal, with K-wire fixation

CLINICAL INDICATIONS: Patient has very painful, intractable plantar keratoma since 2002, previously excised as a verruca by another physician. X-rays indicate third metatarsal is plantarflexed by approximately 3mm.

OPERATIVE DESCRIPTION: Patient was placed in the dorsal recumbent position following IV solution introduction. Utilizing IV sedation, the patient’s right foot was locally anesthetized utilizing 10 cc 2% Xylocaine. Utilizing an Esmarch bandage for exsanguination, the tourniquet was inflated to 250 mmHG. Using a #15 blade, a curvilinear excision was made on the dorsal aspect of the third right metatarsal shaft extending distal to the base of the proximal phalanx. The incision was deepened using sharp dissection. Small blood vessels encountered were clamped and cauterized. Dissection was continued through the deep fascia with curved Metzenbaum’s and the third right metatarsal head was isolated and identified. The periosteum was incised longitudinally.

Collateral ligaments were excised, exposing the metatarsal head and the surgical neck. Utilizing a Sagittal saw, a distal osteotomy was performed from distal to proximal, leaving the plantar cortex intact as a hinge. Feathering the osteotomy to allow a 3 mm elevation of the metatarsal was performed. The osteotomy was fixed with a 0.45 wire from proximal dorsal to distal plantar. Inspection of the osteotomy site was done and it was deemed to be stable. The wire was bent and cut in the appropriate manner. The area was flushed with saline solution. Subcutaneous closure was attained utilizing 3-0 Vicryl. Skin closure was attained using 4-0 nylon. A sterile compression dressing was applied. Patient tolerated the procedure well.

Code this scenario with ICD-9-CM, ICD-10-CM and PCS codes.

 

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