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AHA Coding Clinic® for HCPCS - 2021 Issue 2; Ask the Editor

Lapidus bunionectomy with osteotomy

Patient with left hallux valgus and second metatarsal overload presents for Lapidus bunionectomy with Akin osteotomy and second metatarsal osteotomy. Incisions were made over the medial eminence and down to the capsule layer where a capsulotomy was performed. Dissection was carried further to expose the medial eminence which was removed by saw. Lateral capsular release was performed to manipulate the toe. Incision was made to expose the tarsometatarsal (TMT) joint down to the subcutaneous layer and cartilage and subchondral bone was removed and the joint was reduced and in good alignment. The Lapidus plate was inserted and secured in place with interlocking screws and the capsule closed. After examination, a lateral deformity of the proximal phalanx was observed and incisions were made on either side to perform the Akin osteotomy, removing a small wedge of bone to achieve alignment. Both incisions were closed.Next, a dorsal incision, over the second metatarsophalangeal joint, was carried down to the joint capsule and a Weil-type osteotomy was performed for shortening. The joint was secured in place with a guide pin and a screw. The joint capsule was repaired and the surgical wound was closed. What are the correct codes for the Lapidus bunionectomy done in conjunction with the Akin osteotomy and second metatarsal osteotomy? ...

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