Arthtoplasty coding with MPJ Capsulotomy

The combination of digital arthroplasty and MPJ capsultomy is one of the more common podiatric surgical scenarios of the forefoot. I find it interesting that the speaker at the meeting was rather adamant on this issue considering the following:

1. 28270 is defined as: Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure) Thus if a separate incision was made to correct the MPJ contraction, there is no question this should be paid, even if on the same digit where a surgical arthroplast,y, 28285, was performed.

2. Typically when performing a digital arthroplasty for hammertoe correction, a soft tissue contraction test was perfomed pre-operatively, and it would be known in advance if that was sufficient to correct the deformity. What cannot be determined pre-operatively is if an MPJ capsulotomy will be required to make the correction, post arthropastly. That determination is typically an intra-operative decision, post bone resection.

3. Typcially after a digital artthroplasty is performed and correction is not sufficient, the surgeon makes a more proximal and separate incision. Thus the 28270 is qualified as a separate procedure.

4. Whiere the speaker may be going with their opinion is there is a CCI modifier for 28285 and 28270. My opinion is this is because the definitino of 28270 requires a separate procedure (incision). If there was one long incision, the speaker's argument may be relevant.

5. What of those who perform a digital arthroplasty via two semi elliptical transverse incisions. There is no doubt in this case, there would be no doubt that a separate procedure would be required.

In my opinion, thus the way to make this work, would be for the operative note to stipulate:

1. One incision was made for each procedure (two separate incisional openings) in order to clearly document that two separate procedures were performed and and not made through the same incision.

2. Document the structures noted through the capsultomy procedure (e.g. MPJ capsule) would not be able to be identified at the PIPJ despite adequate resection of the proximal phalangeal head.

3. Be sure to note the lack of correction of the hammertoe correction and continued MPJ contraction post digital arthtoplasty.

   From the coding perspective;

4. Be prepared to use and defend the 59 modifier (as above), so as to make the above clear.