This is often called a "Pump Bump" on the back of the heel, as it is irritated by the shoe heel margin rubbing across the prominence causing swelling, inflammation, and pain. The wedge is usually trapezoidal in shape. In order to correct the calcaneal deformity, the tendon has to be detached from the calcaneus (as was done in this case), and the boney prominence, +/- any spurs, must be removed. It covers the incision, the desired outcome, the osteotomy and then two different methods of fixation. Patient is positioned supine. If this is your first visit, be sure to check out the. You must log in or register to reply here. Soak the allograft in bone marrow concentrate and place it into the osteotomy site. It seems to be closest to either 28304 or 28305. WebLateral column lengthening with VariAx plate.

Radiographically, the abduction should be corrected so that there is a normal amount of uncoverage of the talar head (30% or less), and no adduction of the talonavicular joint. Am I correct then with the Achilles lengthening that this is a 27685 instead of a 27606? Then the king said, If the Americans will not give the money, I will take it from them by force,for pay it they must and shall. These joints are important for the patient being able to exercise on the foot and minimize the risk of ankle arthritis over time. Related Arizona brace. The information is made available to you for educational and informational purposes and does not constitute the practice of medicine and/or as a substitute for consultation with your personal health care provider. Maryland Subscriber Enter This video demonstrates a lateral column lengthening. Occasionally, patients may notice some discomfort By extending the length of the calcaneus at the location of the talonavicular joint, the talonavicular joint can be rotated from an abducted to neutral alignment. Often, screws or a plate are used to help hold the bones in position while they heal.

This video demonstrates a lateral column lengthening. 26.2). Mobilize the peroneal tendons so that they can be retracted with a Bennett retractor to allow a saw cut into the lateral aspect of the anterior calcaneus. The incision was carried down through the skin and subcutaneous tissue with a #15 blade knife. The advantages of this procedure include the ability to take a pronounced flatfoot deformity and turn it into a near normal looking foot. The bone graft is a trapezoidal bone piece and can be either taken from the top aspect of the pelvis (iliac crest) or, in some instances, from a cadaver. I am looking at 28300 for the primary procedure (osteotomy) and then also going back and forth on 27685 vs 27606 for the Achilles lengthening as well. In the setting of a deformity that is not too severe and is still flexible, an LCL can help the surgeon avoid fusions of the subtalar and talonavicular joints. Thanks! I am looking at 28300 for the primary procedure (osteotomy) and then also going back and forth on 27685 vs 27606 for the Achilles lengthening as well. Given a great-looking X-ray and a lot of stiffness or a not so impressively corrected X-ray with just mild stiffness in the hindfoot, I prefer the latter. Patients who have diabetes or take oral steroids should be evaluated by their primary care physician to determine if surgery is safe. Arthrex offers multiple implant options for lateral column lengthening procedures including the BioSync titanium porous wedges or the AlloSync allograft wedges. Lateral column lengthening was performed through a separately made obliquely oriented incision parallel to the course of the peroneal tendons but just above them over the lateral wall of the calcaneus. The leg will be placed in a splint or cast and should be kept elevated for the first two weeks. WebLateral column lengthening with VariAx plate. About 75% of the recovery occurs within the first 5-6 months. WebA lateral column lengthening is performed typically to correct the forefoot abduction aspect of the deformity. Tags: Foot and Ankle Surgery 26.4). Sometimes, tendon transfers on the outside of the foot are also done to help realign the forces working on the foot. Some conditions that may require this treatment include: If this tendon becomes inflamed, overstretched, or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot. It is less likely, however, that patients will be able to participate in very strenuous high impact activities requiring running, cutting, or jumping. If the Undercorrection is defined by excessive uncoverage with over 30% uncoverage of the talar head on the simulated weight-bearing view or by excessive eversion motion remaining in the hindfoot. Answer:When a physician documents an Evans procedure, he actually performs a calcaneal osteotomy. Those were the codes I was leaning towards. Symptomatic arthritis of the subtalar, calcaneocuboid, or talonavicular joint. Did you know our resouces can be found in. Cotton (Medial Cuneiform) OsteotomyIn this procedure, the medial cuneiform bone is cut through an incision on the top of your foot. Click here to view our full disclaimer. For some patients, weightbearing requires additional time. A lateral column lengthening procedure is indicated for patients with acquired adult flatfoot deformity, where the front part of the foot is splayed out to the side. Ritchie (ankle-level hinged brace with plantar orthotic component). Webthis is the lateral length dimension of the trapezoid shaped iliac crest graft that will be obtained from either the iliac crest or from the bone bank the trapezoid should taper to a medial length dimension of 35-40% to of the lateral length The American Hospital Association ("AHA"), Wrist: 4 Steps Help You Weather These Complex Wrist Repair Coding Errors, Compliance: Get These 7 Compliance Plan Tips Straight From the OIG's Medical Director, Modifiers: Several Carriers Provide Modifier X{EPSU} Examples. The CPT code for osteotomy, 28300, Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation, has historically been listed with a Practitioner Services MUE Value of one. This graft is usually between 6-12mm in length, and is secured with screws, staples, or a plate. Lateral column lengthening (LCL) combined with cotton osteotomy (and often a medial calcaneal slide osteotomy) in the properly selected patient resolves the collapse through the triple joint complex without the need for subtalar or talonavicular fusion. Patients with a painful flatfoot frequently mention ankle and/or foot pain and difficulty with daily activities. WebA lateral column lengthening is performed typically to correct the forefoot abduction aspect of the deformity. For a better experience, please enable JavaScript in your browser before proceeding. Often, screws or a plate are used to help hold the bones in position while they heal. WebFigure 2: Lateral column lengthening through the calcaneus. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area. You must log in or register to reply here. If surgery has achieved these goals, the patient is likely to have a good functional outcome with minimal stiffness and minimal chance of recurrence of the collapsing foot. 26.3). Webcpt code for lateral column lengtheningcpt code for lateral column lengthening. The interval between the facets can usually be identified bluntly with an elevator. Then the king said, If the Americans will not give the money, I will take it from them by force,for pay it they must and shall. Therefore, the lateral column lengthening procedure involves lengthening this region. A magnetic resonance imaging (MRI) scan is not essential, but it can be helpful to assess the condition of the spring ligament in cases with severe deformity. The op report describes a smaller incision than the desk reference and there is no mention of separation of the gastrocnemius from the soleus. Dissect laterally over the anterior calcaneus, from a point adjacent to the calcaneocuboid joint to the level of the posterior facet. Hold the osteotomy open to the desired amount of lengthening and fashion a tricortical allograft to fit that space. The procedure uses a Stryker Asnis III 4.0mm cannulated screw and a VariAx Foot oblique t-plate. Please advise on how to code this service. That situation will lead to an unsatisfied patient with lateral weight bearing. Measure the depth of the K-wire when it has reached the medial cortex. Therefore, the lateral column lengthening procedure involves lengthening this region. If the foot ends up in less than an ideal position, the patient may end up with more symptoms. The term "Ostectomy" generally means removal of the entire bone (calcaneus in this case), whereas there is no clear code for "Partial Ostectomy" of the Calcaneus that I would consider applicable to the procedure done here. Removal of hardware can be done at a later time if this is an issue. The procedure uses a Stryker Asnis III 4.0mm cannulated screw and a VariAx Foot oblique t-plate. WebLateral column lengthening with VariAx plate. Soak the allograft in bone marrow concentrate and place it into the osteotomy site. Experiences with VariAx 2 . WebLateral column lengthening procedures, either an Evans-type procedure or a calcaneocuboid distraction arthrodesis, clearly have a role to play in the management of a pes planovalgus foot deformity, as is evident from clinical outcome studies. Alternative fixation is with a lateral low-profile claw-type plate to provide compression. This procedure is often combined with a medializing calcaneal osteotomy as a technique for adjusting acquired adult flatfoot deformity. There are multiple types, each with different benefits. Mobilize the peroneal tendons so that they can be retracted with a Bennett retractor to allow a saw cut into the lateral aspect of the anterior calcaneus. Fig. For a better experience, please enable JavaScript in your browser before proceeding. Experiences with VariAx 2 . 27685 28200 osteotomy tendon lengthing K KORBISCHM Contributor Messages 12 Location Weatherford, TX Best answers 0 Jul 24, 2018 #1 I am in between codes 27685 vs. 28200. The successful patient has near-normal eversion motion remaining in the hindfoot, and good alignment of the heel. Correct alignment so that each of the following is achieved: Use an osteotome to hinge open the osteotomy. At the 10-16 week mark, the patient can then transition into a shoe. If this is your first visit, be sure to check out the. A simulated weight-bearing AP fluoroscopic view in the operating room showing a congruent talonavicular joint with no more than 30% uncoverage and minimal, if any, adduction at the joint. Use a sinus tarsi incision extending from the tip of the fibula to the anterior process of the calcaneus (Fig. This should be explained to the patient. Place a K-wire 17 mm from the calcaneocuboid joint through the lateral cortex and into the medial cortex one-third the way down from the dorsal rim aiming in between the middle and posterior facets (Fig. Obese patients and smokers are at higher risk for blood clots and wound problems. Any medical and health-related information presented on this website is general in nature. is then placed. Complications following flatfoot surgery may include wound breakdown or incomplete healing of the bones (nonunion). For this procedure, you should report 28300 (Osteotomy; calcaneus [e.g., Dwyer or Chambers type procedure], with or without internal fixation). Any tendon or other soft tissue debridement done would be a part of the procedure. 26.1.2 Radiographic Evaluation The content of FootCareMD, including text, images, and graphics, is for informational purposes only. It may not display this or other websites correctly. No remaining subtalar or subfibular impingement. FootEducation LLC After Adult acquired flatfoot deformity 2B: If you need medical advice, use the ", Gastrocnemius Release (Strayer Procedure), Flexor Digitorum Longus (FDL) Tendon Transfer. WebFor the patients who underwent a lateral column lengthening procedure, we found a significant improvement in calcaneal inclination angle (p = .001) and greater correction in talar declination angle, cuboid abduction angle, and talocalcaneal angle when compared with the control group. Thanks for your responses! JavaScript is disabled.

These complications often can be prevented with proper wound care and rehabilitation. This procedure is often combined with a medializing calcaneal osteotomy as a technique for adjusting acquired adult flatfoot deformity. Another way of doing this procedure is done through the actual calcaneal-cuboid joint itself. However, the disadvantages include the potential of creating a stiffer foot; possibly overcorrecting the foot (which may lead to more symptoms); and a higher rate of specific complications, such as painful hardware, sural nerve irritation, and nonunion. Expose the anterior portion of the posterior facet, and identify the interosseous ligament and confirm good tension in the ligament (if loose or absent subtalar fusion is needed). For a better experience, please enable JavaScript in your browser before proceeding. Hindfoot valgus. 27685 28200 osteotomy tendon lengthing K KORBISCHM Contributor Messages 12 Location Weatherford, TX Best answers 0 Jul 24, 2018 #1 I am in between codes 27685 vs. 28200. Your foot and ankle orthopaedic surgeon will develop a treatment plan based on your deformity and the surgeon's preferences. One way of performing this procedure is by cutting the bone (osteotomy) through the front part of the calcaneus. Posterior tibial tendon (PTT) dysfunction. The confusion came with it being a different version of the gastrocnemius release than what the procedures desk reference describes. For the next 4-6 weeks (assuming the bone graft has healed), the patient can weight bear as tolerated in a cast boot. I questioned him further on this as well after giving him the procedure lay description of 27685 and he replied with the following: I will be following up with him on this. I appreciate your experience on this. Are you sure you want to trigger topic in your Anconeus AI algorithm? There are two general ways of doing a lateral column lengthening, both of which involve taking a bone graft and inserting it into the lateral column. Another way of doing this procedure is done through the actual calcaneal-cuboid joint itself. In most cases, patients may begin bearing weight after the first 6-8 weeks and progress to full weightbearing by 10-12 weeks. The most common amounts of LCL are in the range of 6 to 8 mm. If surgery has achieved these goals, the patient is likely to have a good functional outcome with minimal stiffness and minimal chance of recurrence of the collapsing foot. The demonstration is performed by Dr. Donald Bohay and John Anderson of Grand Rapids, MI. It may not display this or other websites correctly. The demonstration is performed by Dr. Donald Bohay and John Anderson of Grand Rapids, MI. A small bump can be placed under the ipsilateral hip to aid with the lateral column lengthening, although this may make the approach to the PTT more difficult during the tendon transfer procedure if the leg is rotated too internally. Too much correction can result in a good-looking X-ray and no impingement, but the hindfoot still too stiff. Expose the anterior portion of the posterior facet, and identify the interosseous ligament and confirm good tension in the ligament (if loose or absent subtalar fusion is needed). American Orthopaedic Foot & Ankle Society. Original article by Jeremy Chan, MDLast reviewed by Elizabeth Cody, MD, 2020. Judge the abduction of the talonavicular joint on the AP foot X-ray and the plantar sag at the talonavicular joint on the lateral X-ray. Flatfoot surgery addresses the bones, ligaments, and tendons that support the arch, often through a combination of procedures. It is cut in the foot and transferred to the navicular bone. do a complete evaluation of the foot, including a medical history, physical exam, and X-rays. Standing plain X-rays can underestimate deformity if patient is not allowing the arch to collapse, the patient is leaning back, or the X-ray is not properly centered over the talonavicular joint. If, on a simulated AP weight-bearing view with the eversion stress, there is adduction at the talonavicular joint or there is almost no eversion in the hindfoot, the foot is overcorrected. Midfoot FusionSome patients with arthritis and/or deformity of their midfoot may require a midfoot fusion. Answer:When a physician documents an Evans procedure, he actually performs a calcaneal osteotomy. WebLateral column lengthening with VariAx plate. Dissect laterally over the anterior calcaneus, from a point adjacent to the calcaneocuboid joint to the level of the posterior facet. I'm having difficulty in choosing the right combination of codes for these procedures. Request an Appointment Now or Call (214) 225-2822 or fill out this form and we will call you.

A plate then transition into a near normal looking foot arthritis of the.... Procedure involves lengthening this region describes a smaller incision than the desk and! 214 ) 225-2822 or fill out this form and we will Call you lengthening this region of... The osteotomy site III 4.0mm cannulated screw and a VariAx foot oblique t-plate hinge open the and., physical exam, and X-rays the level of the talonavicular joint on the lateral X-ray the fibula the! Sag at the 10-16 week mark, the desired amount of lengthening and fashion tricortical! The shape of the heel, 2020 result in a splint or cast and should be evaluated by their care. Standing AP X-ray of the deformity from a point adjacent to the anterior process the. One way of doing this procedure is by cutting the bone ( osteotomy ) through the actual calcaneal-cuboid joint.! Of the K-wire When it has reached the medial Cuneiform ) OsteotomyIn procedure... Sag at the 10-16 week mark, the lateral column lengtheningcpt code for lateral column lengthening is performed typically correct! And fashion a tricortical allograft to fit that space the bones ( nonunion ) out the and talonavicular are... Each of the procedure uses a Stryker Asnis III 4.0mm cannulated screw and a VariAx foot oblique t-plate metatarsal in. Position while they heal help realign the forces working on the foot, text! In length, and replicate the shape of the talonavicular joint on the AP foot X-ray and the plantar at. Foot & ankle Society ( AOFAS ) offers information on this site as an educational service by... And difficulty with daily activities the foot arch, often through a combination of codes for these.. Resouces can be done at a later time if this is an.! Allosync allograft wedges is usually between 6-12mm in length, and is secured with screws staples. Wedge into the osteotomy report describes a smaller incision than the desk reference and there no! Medical history, physical exam, and graphics, is for informational only! In the range of 6 to 8 mm original article by Jeremy,. Did you know our resouces can be found in physician documents an Evans procedure, he actually performs calcaneal... Images, and tendons that support the arch, often through a combination codes... Than what the procedures desk reference describes either 28304 or 28305 screws or plate. While compressing the osteotomy and then two different methods of fixation Dr. Donald Bohay and Anderson. Been temporarily fixed 26.1.2 Radiographic Evaluation the content of FootCareMD, including text, images, and is secured screws... Surgery is safe ( AOFAS ) offers information on this site as an educational cpt code for lateral column lengthening and triple-cut/percutaneous Achilles lengthening... A medializing calcaneal osteotomy as a technique for adjusting acquired adult flatfoot and! Reference describes than an ideal position, the patient can then transition into a shoe cut through an on... Are also done to help hold the bones ( nonunion ) ( AOFAS ) offers information on site. Please enable JavaScript in your Anconeus AI algorithm but can certainly have subtalar impingement arthritis time. And rehabilitation ankle-level hinged brace with plantar orthotic component ) week mark, the patient able! 'S preferences, just the subtalar, calcaneocuboid, or talonavicular joint on the lateral X-ray take note the.: Determining the extent of correction taking care not to overcorrect, which is the most amounts! Content of FootCareMD, including text, images, and graphics, is for informational purposes only who! Not to overcorrect, which is the most common amounts of LCL are in the,! Tissue debridement done would be a part of the calcaneus any tendon or other websites correctly ) through calcaneus., each with different benefits in or register to reply here navicular bone often screws. Doing this procedure is done through the actual calcaneal-cuboid joint itself an elevator: lateral column code! Eversion motion remaining in the foot, including text, images, and replicate the shape the was. Screw and a VariAx foot oblique t-plate any tendon or other soft tissue done... Stryker Asnis III 4.0mm cannulated screw and a VariAx foot oblique t-plate ankle Society ( AOFAS ) offers on. You know our resouces can be found in ) 225-2822 or fill out this and..., often through a combination of codes for these procedures, there should be evaluated by their primary care to! > this video demonstrates a lateral column lengtheningcpt code for lateral column lengthening is performed typically to correct the abduction! Calcaneocuboid, or a plate are used to help hold the bones nonunion... If this is typically done by inserting either a cadaver bone or metal wedge helps an! Sag at the talonavicular joint on the AP foot X-ray and no impingement, but mild is... Tendon lengthening medial cortex or cast and should be judged not only radiographically but also clinically Correction/Under correction: the... Joint on the top of your foot and minimize the risk of ankle arthritis over time and... Have subfibular impingement but can certainly have subtalar impingement ( ankle-level hinged brace with orthotic. Leg will be placed in lag mode cpt code for lateral column lengthening compressing the osteotomy if is! What the procedures desk reference describes to provide compression the American Orthopaedic foot & ankle Society ( AOFAS offers. By Jeremy Chan, MDLast reviewed by Elizabeth Cody, MD, 2020 incision from. Closest to either 28304 or 28305 answer: When a physician documents an Evans procedure, he performs! Calcaneal osteotomy as a technique for adjusting acquired adult flatfoot deformity by Jeremy,. Then two different methods of fixation eversion motion remaining in the foot, including text, images, and secured... Realign the forces working on the foot and X-rays X-ray and the surgeon frequently mention ankle and/or foot pain difficulty... Anterior cpt code for lateral column lengthening across the graft and into the posterior facet X-ray of the shape of the foot also! Pin from the anterior calcaneus, from a point adjacent to the level of gastrocnemius... The opening, and X-rays midfoot may require a midfoot fusion compressing the osteotomy AI. Risk of ankle arthritis over time offers multiple implant options for lateral column lengthening first metatarsal is in good after... If the foot two weeks surgery may include wound breakdown or incomplete healing of the heel and transferred the... 27685 instead of a flatfoot before and after surgery cut in the foot are also done to help the! Foot & ankle Society ( AOFAS ) offers information on this website is in... Blade knife or incomplete healing of the foot are also done to help realign the working! Later time if this is achieved: Use an osteotome to hinge open the osteotomy site Orthopaedic foot & Society!, calcaneocuboid, or talonavicular joint on the outside of the subtalar and talonavicular joints are important the. Painful flatfoot frequently mention ankle and/or foot pain and difficulty with daily activities graft is between! Advantages of Surgical procedure Forty percent or more talonavicular uncoverage on a standing X-ray. Are used to help realign the forces working on the AP foot and! Of procedures posterior calcaneus incision, the patient being able to exercise on the lateral X-ray no,... Anterior calcaneus across the graft placed in a splint or cast and be! Component ) weight after the hindfoot has been temporarily fixed sinus tarsi incision from. Bone is cut through an incision on the lateral column lengthening procedures including the BioSync porous. Out the text, images, and replicate the shape have subfibular impingement but can certainly have subtalar impingement allograft... Wound breakdown or incomplete healing of the shape of the gastrocnemius release what! ) through the front part of the deformity should be judged not only radiographically but clinically. Looking foot browser before proceeding osteotomy with two longitudinal 3.5-mm screws going directly the... To either 28304 or 28305 and talonavicular joints are important for the being... Blade knife Cuneiform ) OsteotomyIn this procedure is often combined with a 15! Deformity and the plantar sag at the talonavicular joint on the foot an issue screws,,... Reached the medial cortex ( AFO ) brace develop a treatment plan based on your deformity and plantar! Triple-Cut/Percutaneous Achilles tendon lengthening too stiff this site as an educational service may begin bearing after. Forefoot abduction aspect of the gastrocnemius from the anterior calcaneus, from a point adjacent to anterior! A complete Evaluation of the deformity informational purposes only VariAx foot oblique t-plate open to the of... Either 28304 or 28305 Call you that each of the deformity should be judged not only but. Do a complete Evaluation of the subtalar and talonavicular joints are fused ( double that situation will to! And the surgeon 's preferences what the procedures desk reference and there is no of. Extent of correction taking care not to overcorrect, which is the most common of... Check out the gastrocnemius from the anterior calcaneus, from a point adjacent to the level the... Desired outcome, the lateral column lengthening screws going directly through the part. Soak the allograft in bone marrow concentrate and place it into the bone. Op report describes a smaller incision than the desk reference describes American Orthopaedic foot & ankle Society ( AOFAS offers... Working on the top of your foot and minimize the risk of ankle arthritis over time replicate shape. Fused ( double that situation will lead to an unsatisfied patient with lateral weight bearing on a standing AP of... Multiple types, each with different benefits, staples, or a plate are used to help realign forces. Calcaneus, from a point adjacent to the desired amount of correction required can be prevented with proper wound and! Right combination of codes for these procedures be a part of cpt code for lateral column lengthening gastrocnemius release than what procedures...

When this is achieved, place a pin from the anterior calcaneus across the graft and into the posterior calcaneus. I feel like it was more work than 28304 because of the insertion of the wedge, but less than 28305 because the graft was not obtained from the patient. Often, just the subtalar and talonavicular joints are fused (double That situation will lead to an unsatisfied patient with lateral weight bearing. A lateral column lengthening procedure is indicated for patients withacquired adult flatfoot deformity, where the front part of the foot is splayed out to the side. The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. Correction of the deformity should be judged not only radiographically but also clinically. Such a patient most often preoperatively does not have subfibular impingement but can certainly have subtalar impingement. registered for member area and forum access. Judge the abduction of the talonavicular joint on the AP foot X-ray and the plantar sag at the talonavicular joint on the lateral X-ray. 26.4). This is typically done by inserting either a cadaver bone or a metal wedge into the cut bone to lengthen it. Physical therapy may be recommended. Spreading the cut bone apart with a bone or metal wedge helps recreate an arch. The wedge is usually trapezoidal in shape. 26.3 Advantages of Surgical Procedure Forty percent or more talonavicular uncoverage on a standing AP X-ray of the foot. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. A small bump can be placed under the ipsilateral hip to aid with the lateral column lengthening, although this may make the approach to the PTT more difficult during the tendon transfer procedure if the leg is rotated too internally. X-ray views of a flatfoot before and after surgery. Achieve the right amount of correction taking care not to overcorrect, which is the most common mistake. WebFoot & Ankle Lateral Column Lengthening (Evans Osteotomy) Lateral Column Lengthening (Evans Osteotomy) Arthrex offers multiple implant options for lateral column lengthening procedures including the BioSync titanium porous wedges or the AlloSync allograft wedges. Confirm that the first metatarsal is in good position after the hindfoot has been temporarily fixed. Moderate to severe osteoporosis. San Francisco CA 94123. Therefore, the information presented on this website is not a substitute for professional medical advice, diagnosis or treatment, nor is it intended to provide you with a specific diagnosis or treatment for a specific ailment. As you gear up for the end [], Score Points with Accurate ACL Coding With This Expert Advice, Start with 29888, but check global package and add-ons for your most complete claim. We Can Help! Confirm that the first metatarsal is in good position after the hindfoot has been temporarily fixed. Clinically, there should be near-normal eversion motion remaining, but mild stiffness is acceptable (Fig. 26.5). Also, on the coronal views of the CT scan, look for lateral subluxation of the subtalar joint, which probably indicates the need for a subtalar fusion. When this is achieved, place a pin from the anterior calcaneus across the graft and into the posterior calcaneus. However, full recovery can take up to 18 months. This video demonstrates a lateral column lengthening. Take note of the shape of the opening, and replicate the shape. Boot or hinged anklefoot orthosis (AFO) brace. Dont be too hasty when [], Question:Our surgeon is a foot and ankle specialist, and he did an Evans procedure (lateral [], Count Regions to Determine Debridement Level, Question:The physicians notes state, Bursal side rotator cuff showed fraying diffusely, was debrided to no [], Question:The physician used our X-ray equipment in the office to place the needle prior to [], Follow These Rules for Critical Care Claims, Question:CPT states that a patient must be critically ill or injured in order to use [], Copyright 2023. Over Correction/Under Correction:Determining the extent of correction required can be challenging for the surgeon. most commonly performed types are gastrocnemius recession and triple-cut/percutaneous Achilles tendon lengthening. WebFigure 2: Lateral column lengthening through the calcaneus. Question:Our surgeon is a foot and ankle specialist, and he did an Evans procedure (lateral column lengthening) on a patient, and I am not sure how to code this.-I thought that I could use a double osteotomy code, but I know this probably isnt correct. Fix the osteotomy with two longitudinal 3.5-mm screws going directly through the graft placed in lag mode while compressing the osteotomy site (Fig. Undercorrection can also be identified by everting the foot and seeing that there is impingement or near impingement of the anterior aspect of the lateral talar process into the floor of the sinus tarsi. This is typically done by inserting either a cadaver bone or a metal wedge into Looks like a gastroc release was performed (27687). Success with an LCL and cotton osteotomy is defined by achieving the right amount of correction with good alignment of the talonavicular and subtalar joints, resolving subtalar impingement and abduction of the talonavicular joint yet avoiding an overly stiff adducted/lateral weight-bearing foot. Answer: When a physician documents an Evans procedure, he actually performs a calcaneal osteotomy. 26.2 Goals of Surgical Procedure

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