metatarsophalangeal joint

“I have an unusual situation that I am trying to figure out how to code. I had a patient return to the office in the global period after I performed a 1st metatarsophalangeal joint (MTPJ) arthrodesis. Although, the alignment of the fusion looks good, one of the non-locking screws advanced out of the bone and plate and started to tent the skin at the incision site at three weeks post operative. She is neuropathic and denied any trauma to the area. I removed the screw in the office with local anesthesia. Can I bill for unplanned screw removal in the office?”

“I was consulted on a patient in the hospital with a large 5th metatarsophalangeal joint ulceration. There was osteomyelitis of the proximal phalanx and metatarsal head. I performed the resection and subsequently performed a delayed closure several days later. The closure left an area open due to soft tissue deficit. This necessitated post operative wound care. I initially billed CPT 28810 and then subsequently CPT 13160. I billed CPT 11042 weekly post operatively, until the wound healed. The private insurance states that all the CPT 11042 billings are considered part of the global.”

“What is the proper CPT code for percutaneous capsulotomy and tenotomy of metatarsophalangeal joint?”