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Osteotomy of the talus is a surgical procedure aimed at correcting deformities of the foot that may be congenital (present at birth) or acquired due to various factors such as injury or disease. The talus is a critical bone in the ankle joint that plays a significant role in foot mechanics and stability. During the procedure, a skin incision is made either on the lateral (outer) or medial (inner) side of the talus to gain access to the bone. Careful dissection is performed to expose the talus while protecting the surrounding structures, including nerves, blood vessels, and tendons, which are vital for foot function. The procedure can involve two types of osteotomies: a closing wedge osteotomy or an opening wedge osteotomy. In a closing wedge osteotomy, a wedge-shaped section of bone is excised from the talus, allowing the remaining bone to be realigned by closing the gap. Conversely, in an opening wedge osteotomy, a wedge is removed from one side of the talus, and the bone is cut on the opposite side to create an opening that is then filled with the removed wedge or additional bone graft material. Fixation with pins or screws is often utilized to ensure that the hindfoot remains properly aligned during the healing process. This procedure is essential for restoring normal foot function and alleviating pain associated with deformities of the talus.
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Osteotomy of the talus is indicated for various conditions affecting the foot, particularly those that result in deformities. The following are specific indications for performing this procedure:
The procedure for osteotomy of the talus involves several critical steps to ensure proper correction of the deformity. The following outlines the procedural steps:
Post-procedure care following an osteotomy of the talus is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or improper healing. Pain management strategies are implemented to ensure patient comfort. Weight-bearing restrictions may be advised, and the use of a walking boot or crutches is often recommended to protect the surgical site during the initial healing phase. Physical therapy may be initiated to restore mobility and strength in the foot as healing progresses. Follow-up appointments are crucial to assess the alignment and healing of the talus and to make any necessary adjustments to the rehabilitation plan.
| Short Descr | INCISION OF ANKLE BONE | Medium Descr | OSTEOTOMY TALUS | Long Descr | Osteotomy; talus | 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 | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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