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An osteotomy of the proximal tibia is a surgical procedure that involves cutting and reshaping the upper part of the tibia, which is the larger bone in the lower leg. This procedure may also include the excision of a portion of the fibula, which is the smaller bone located alongside the tibia. The primary purpose of this surgery is to correct deformities of the knee, specifically genu varus, commonly known as bowleg, and genu valgus, referred to as knock-knee. The decision to perform this procedure is based on the specific type and location of the deformity, which can vary among patients. Various techniques can be employed during the osteotomy, including transverse, wedge, sliding, right or left angle, V-osteotomy, and Z-osteotomy, each chosen based on the individual case requirements. Prior to the surgery, the physician utilizes radiographic studies to determine the precise location and configuration of the bone cut necessary to achieve optimal alignment and correction of the deformity. The procedure is typically performed through an incision made over the lower leg, allowing for the careful dissection of soft tissues to expose the tibia and fibula. The tibial periosteum, a layer of tissue surrounding the bone, is elevated to facilitate access. The bone is then cut using specialized instruments such as drills, saws, or osteotomes, following the predetermined configuration. In some cases, a portion of the fibula may be excised or an osteotomy of the fibula may be performed concurrently. To ensure proper healing and alignment, bone grafts may be placed between the cut segments, and internal fixation devices, such as pins, screws, or plates, are applied as necessary. Alternatively, an external fixation device may be utilized. This procedure is specifically indicated for children or adolescents who have not yet reached epiphyseal closure, as it allows for continued growth and correction of the deformity.
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The osteotomy of the proximal tibia is indicated for specific conditions that affect the alignment and function of the knee joint. The following are the primary indications for this procedure:
The procedure for a proximal tibia osteotomy involves several critical steps to ensure successful correction of the deformity. The following outlines the procedural steps:
After the osteotomy procedure, patients typically require a period of recovery and rehabilitation. Post-operative care may include monitoring for complications, managing pain, and ensuring proper wound healing. Patients are often advised to limit weight-bearing activities on the affected leg for a specified duration, allowing the bone to heal adequately. Physical therapy may be initiated to restore range of motion and strength in the knee joint. Follow-up appointments are essential to assess the healing process and make any necessary adjustments to the treatment plan. The overall recovery time can vary based on individual factors, including age, overall health, and adherence to post-operative instructions.
| Short Descr | REALIGNMENT OF KNEE | Medium Descr | OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL | Long Descr | Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closure | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 161 - Other OR therapeutic procedures on bone |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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