03/16/2016    Barry Mullen, DPM

Met Osteotomy & Plantar Plate Repair (Howard Zlotoff, DPM)

I respectfully disagree with Dr. Zlotoff's coding
reply for a plantar plate repair. He opined
either using a flexor tendon repair code with the
osteotomy code, or an unlisted code. In actually,
when a CPR is correctly performed, one preserves
the long flexor tendon. It is carefully retracted
away from the plantar plate prior to the plate's
incision. Therefore, that code is inappropriate.
I'm unsure about my colleague's experiences using
unlisted codes, but remuneration takes forever
and only after multiple appeals. No thanks! I
avoid them if a suitable code exists that
reflects the work I perform.

So, when we think of the pedal pathology and the
surgical repair, don't almost ALL plantar plate
tears ultimately lead to MTP destabilization,
inevitably creating a pre-dislocation syndrome?
Don't symptoms occur from the subsequent lesser
MTP joint incongruity and joint wear and tear
after it subluxes/dislocates? Isn't this almost
always associated with a long 2nd metatarsal?

Isn't the entire purpose of the plate repair is
to re-establish joint congruity by re-
anastamosing the healthy portion of the plate
back to the base of the proximal phalanx in
anatomical alignment to the lesser metatarsal?
Isn't the Weil osteotomy an integral component of
that repair?

As such, I believe the most accurate CPT code is
28645 which is an open reduction of a metatarsal-
phalangeal joint dislocation, especially since I
have never seen any CPT reference that
distinguishes between acute vs chronic
dislocations when utilizing ORIF codes. While
necessary, I don't believe the osteotomy is
separately billable. This is just my opinion. I
am not a current member of the APMA coding
committee, but do believe my logic validates my
reply.

Barry Mullen, DPM, Hackettstown, NJ

There are no more messages in this thread.