JUly 2015

Interpositional Arthroplasty of the Metatarsophalangeal Joint

As you know, we do have a code set that represents an interpositional arthroplasty of the CMC (carpometacarpal) joint of the wrist, but there isn’t a comparable code for this procedure when performed at the MTPJ (metatarsophalangeal) joint – that is, we don’t have a code that specifically states “interpositional arthroplasty” – so how would you report this procedure?


Another name commonly used to describe this service is a Modified Keller Procedure which is performed for the treatment of osteoarthritis. The procedure starts off like a Keller where the base of the proximal phalanx is removed but then the physician takes the capsule and/or soft tissue and sutures it into the area of the joint to act as a soft tissue interposition (shock absorber) between the two bones.



The base of the proximal phalanx was pulled upward and I removed about 7mm of the base of the proximal phalanx using a sagittal saw cutting perpendicular to the axis of the phalanx. The base of the phalanx was removed and discarded. I now dissected out the capsule of the joint and identified the flexor tendons, they were pulled up and about a 1.5cm segment was removed out of them as well. Now with my soft tissue envelope prepared a suture was placed through the capsule and flexor tendon segment but left untied. A K-wire was passed first retrograde through the toe and then antegrade back into the metatarsal leaving about 8-9mm of space and at this time the suture was tied to the pin pulling the soft tissue into the joint to act as my interpositional material.


Based on a recent inquiry made to the AMA, their recommendation was to code this procedure as 28293 for procedures performed on the great toe and 28126 for procedures performed on toes 2-5.




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