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An osteotomy of the metatarsal bones involves surgical procedures aimed at correcting angular deformities of the foot, specifically targeting the first metatarsal. This procedure can be performed with or without additional techniques such as lengthening, shortening, or angular correction. The primary goal of the osteotomy is to address acquired or congenital deformities, which may include conditions like hallux valgus (a bunion), metatarsus primus varus (a condition where the first metatarsal is angled inward), hallux varus (the opposite of hallux valgus), or dorsal bunion (a bunion on the top of the foot). During the procedure, the first metatarsal is carefully exposed, and the surgical approach may involve incising the metatarsophalangeal (MTP) joint capsule and dividing tendons as necessary to facilitate access to the bone. Depending on the specific deformity being corrected, the osteotomy may require excision that extends over adjacent structures such as the proximal phalanx and/or medial cuneiform bones. The technique employed can vary; for instance, a closing wedge osteotomy involves cutting the metatarsal and removing a wedge of bone to realign the structure, while an opening wedge osteotomy uses a laminar spreader to create space for alignment, often accompanied by the placement of a bone graft. This procedure is particularly relevant in cases where multiple metatarsals require correction, such as in a Swanson type cavus foot procedure, which is designed to restore proper foot function and alleviate pain associated with these deformities.
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The osteotomy procedure described by CPT® Code 28309 is indicated for various conditions affecting the metatarsals, particularly when addressing angular deformities. The specific indications include:
The procedure for performing an osteotomy of the metatarsals, particularly under CPT® Code 28309, involves several critical steps:
After the osteotomy procedure, patients can expect a recovery period that may involve immobilization of the foot to ensure proper healing. The use of a walking boot or cast may be necessary to protect the surgical site. Patients are typically advised on weight-bearing restrictions and may require physical therapy to regain strength and mobility in the foot. Follow-up appointments will be essential to monitor the healing process and assess the alignment of the metatarsals. Any signs of complications, such as infection or misalignment, should be reported to the healthcare provider promptly.
| Short Descr | INCISION OF METATARSALS | Medium Descr | OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT | Long Descr | Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson type cavus foot procedure) | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | 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 | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | 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 |
| 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) | 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 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 | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | T2 | Left foot, third digit | T3 | Left foot, fourth digit | T5 | Right foot, great toe | T6 | Right foot, second digit | T7 | Right foot, third digit | T8 | Right foot, fourth digit | T9 | Right foot, fifth digit | TA | Left foot, great toe | 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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