CPT® Code 28293

Deleted

1. Indications

The procedure described by CPT® Code 28293 is indicated for the following conditions:

• Hallux Valgus: A deformity characterized by the lateral deviation of the big toe, leading to pain and discomfort at the first metatarsophalangeal joint.
• Hallux Limitus: A condition where there is little or no range of motion at the first metatarsophalangeal joint, often accompanied by pain, necessitating surgical intervention.
• Sesamoid Bone Issues: Fractured or inflamed sesamoid bones that may require excision to alleviate pain and restore function.

2. Procedure

The surgical procedure for CPT® Code 28293 involves several detailed steps to ensure effective correction of hallux valgus and the associated conditions:

• Dorsal Incision: A dorsal incision is made over the metatarsophalangeal joint to provide access to the underlying structures. This incision allows the surgeon to reach the joint capsule and surrounding soft tissues.
• Dissection of Soft Tissues: The soft tissues are carefully dissected to expose the joint capsule. This step is crucial for accessing the joint structures that need to be addressed during the procedure.
• Incision of Joint Capsule: The joint capsule is incised, allowing for further dissection of the joint structures. This step is necessary to access the joint for the subsequent procedures.
• Excising Hypertrophic Bone: Any hypertrophic bone present is excised to prepare the joint for the implant. This removal is essential to alleviate pressure and pain associated with the bunion.
• Using a Cutting Guide: A cutting guide is employed to determine the precise amount of bone that needs to be removed from both the proximal phalanx and the metatarsal. This ensures accuracy in the resection process.
• Bone Resection: An oscillating saw is utilized to excise the phalangeal base and metatarsal head, following the guidance of the cutting guide. This step is critical for reshaping the joint appropriately.
• Additional Bone Removal: If necessary, additional bone is removed from the medial eminence to further correct the deformity and prepare the joint for the implant.
• Creating Pilot Holes: A rotary bur is used to create pilot holes in the medullary canals of the bones, which is essential for the subsequent reaming process.
• Reaming Medullary Canals: The medullary canals are reamed to accommodate the implant, ensuring a proper fit and stability once the implant is inserted.
• Trial Sizing Implant: A trial sizing implant is placed to evaluate fit and function before the permanent implant is inserted. This step allows for adjustments to be made as necessary.
• Releasing Soft Tissue Contractures: All soft tissue contractures are released to ensure optimal movement and function of the joint post-surgery.
• Trimming and Smoothing Bone: The bone is trimmed and smoothed as needed to ensure a proper fit for the implant and to reduce any potential irritation.
• Inserting Permanent Implant: The permanent implant is inserted into the joint, with the stems being press fit into the medullary canals to secure the implant in place.
• Attaching Joint Implant: The joint implant is placed and attached to the stems, ensuring stability and proper alignment within the joint.
• Evaluating Fit and Range of Motion: The fit and range of motion of the joint are evaluated to ensure that the implant functions correctly and meets the surgical goals.
• Closing the Joint Capsule: The joint capsule is closed over the prosthesis to protect the implant and facilitate healing.
• Excising Sesamoid Bones: If the sesamoid bones are fractured or inflamed, a skin incision is made over the sesamoid bone, and the bone is excised after careful dissection of the surrounding soft tissues.
• Layered Closure: Finally, the soft tissue and skin are closed in layers to promote optimal healing and minimize scarring.

3. Post-Procedure

Post-procedure care following the correction of hallux valgus with CPT® Code 28293 typically involves monitoring for any signs of complications, managing pain, and ensuring proper healing of the surgical site. Patients may be advised to keep the foot elevated and to limit weight-bearing activities for a specified period to promote recovery. Follow-up appointments are essential to assess the healing process, evaluate the function of the implant, and make any necessary adjustments to the rehabilitation plan. Physical therapy may be recommended to restore range of motion and strength in the affected foot. Additionally, patients should be educated on proper footwear choices to prevent recurrence of the bunion and to support overall foot health.