cpt code for lateral column lengthening

1. Epub 2021 Feb 12. PROCEDURE: Accessibility For 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. Take note of the shape of the opening, and replicate the shape. Take note of the shape of the opening, and replicate the shape. sharing sensitive information, make sure youre on a federal Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. An unusual midfoot injury pattern: Navicular-cuneiform and calcaneal-cuboid fracture-dislocation. with or without lengthening, shortening or angular correction, metatarsal; first metatarsal 28310 Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe . The guiding principle behind the lateral column lengthening is to bring the forefoot and midfoot out of abduction while using the foot's natural bony architecture to drive the hindfoot into inversion and dorsiflexion. Perform compression fixation of the osteotomies, especially the LCL. In most cases, the full operative reports would PREOPERATIVE DIAGNOSES: Effects of five hindfoot arthrodeses on foot and ankle motion: Measurements in cadaver specimens. 2013 Dec;6(4):294-303. doi: 10.1007/s12178-013-9173-z. The https:// ensures that you are connecting to the Indication for this procedure is excessive eversion/abduction of the midfoot with collapse of the arch as evidenced by one of the following: Forty percent or more talonavicular uncoverage on a standing AP X-ray of the foot. 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. 26.1). Unable to load your collection due to an error, Unable to load your delegates due to an error. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) This should be explained to the patient. 2. Bookshelf Special hardware holds the graft and the bone together so they can grow together to form one bone. The successful patient has near-normal eversion motion remaining in the hindfoot, and good alignment of the heel. An official website of the United States government. Same Lateral column lengthening (Evans Osteotomy) for adult acquired flatfoot is a surgical procedure designed to modify the shape of the foot and create an arch. It seems to be closest to either 28304 or 28305. Right triple arthrodesis Read a CPT Assistant article by subscribing to. To schedule an appointment online, clickHERE. I think you're on the right track. If available, obtain a standing computed tomography (CT) scan in cases of severe deformity. This procedure is often combined with a medializing calcaneal osteotomy , (often referred to as the "All American procedure"), as a technique for adjusting acquired adult flatfoot deformity . This site needs JavaScript to work properly. 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. HHS Vulnerability Disclosure, Help Long plantar ligament strain. Operative treatment of the difficult stage 2 adult acquired flatfoot deformity. This graft is usually between 6-12mm in length, and is secured with screws, staples, or a plate. If there is any space on either side between the graft and native bone, rotate or trim the graft slightly to achieve excellent apposition along the lateral and dorsal aspects of the osteotomy. Over Correction/Under Correction:Determining the extent of correction required can be challenging for the surgeon. Have a question or need help finding the right doctor? For the first 6-10 weeks, the patient is either non-weight bearing or limited weight bearing through the heel, until the bone graft has healed. Sci Rep. 2016 Oct 18;6:35493. doi: 10.1038/srep35493. 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. Too much correction can result in a good-looking X-ray and no impingement, but the hindfoot still too stiff. The new bone graft is held in place by pins that are removed 3-4 weeks after the surgery during your child . Published by Elsevier Inc. All rights reserved. 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. To view a list of all insurances that AOA Orthopedic Specialists accept, clickHERE. FOIA The https:// ensures that you are connecting to the If the first metatarsal is elevated, it should be brought down to a good position in comparison to the second metatarsal head. 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. Would you like email updates of new search results? The CPT codes available in each . 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. Mosier-LaClair S, Pomeroy G, Manoli A 2nd. Best position is toes pointing to the ceiling with the foot at rest. Accessibility It may not display this or other websites correctly. Clinically, there should be near-normal eversion motion remaining, but mild stiffness is acceptable (Fig. Autograft and allograft unite similarly in lateral column lengthening for adult acquired flatfoot deformity. Eur J Orthop Surg Traumatol. Epub 2015 Feb 9. Please enable it to take advantage of the complete set of features! Request an Appointment Now or Call (214) 225-2822 or fill out this form and we will call you. PMC For a lateral column lengthening, orthopedic foot and ankle specialists may use pins, plates, screws, or other types of applicable hardware. Achieve the right amount of correction taking care not to overcorrect, which is the most common mistake. Orthopade. 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. Often the bone graft is taken from the child's pelvis. Clubfoot talipes equinovarus is a common congenital disorder and one that has affected me personally. Despite an abundance of literature intricately detailing the biomechanical effects of different operative procedures on the hindfoot, there is no clear consensus as to the best procedure or procedures to perform for a flexible pes planovalgus foot deformity. Medial displacement osteotomy os calcis - (confident) 28300 San Francisco CA 94123. 2017;2017:4383981. doi: 10.1155/2017/4383981. Federal government websites often end in .gov or .mil. 8600 Rockville Pike 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. POSTOPERATIVE DIAGNOSES: About 75% of the recovery occurs within the first 5-6 months. Assess a standing AP view of the ankle to confirm no valgus of the talus in the ankle joint. Use the pin distractor to hold open the osteotomy and try different amounts of lengthening to correct the deformity. These joints are important for the patient being able to exercise on the foot and minimize the risk of ankle arthritis over time. Lateral 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. Correct alignment so that each of the following is achieved: No remaining subtalar or subfibular impingement. 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. You may also needEvans Lateral Column Lengthening and Cotton OsteotomyTriple ArthrodesisTriple ArthrodesisFlexor Digitorum Longus Transfer for Posterior Tibial Tendon DysfunctionFlexor Digitorum Longus Transfer for Posterior Tibial Tendon DysfunctionNaviculocuneiform Fusion to Treat Midfoot Arthritis and DeformityNaviculocuneiform Fusion to Treat Midfoot Arthritis and DeformityCavovarus Reconstruction The depth of the saw cut can be marked on the saw with a marking pen. 26.1). The .gov means its official. In an osteoporotic patient with significantly weak bone, an Evans procedure is preferable to a step-cut osteotomy (see section Lateral Column Lengthening Alternative Procedure: Step-cut Osteotomy) because of less chance of fracturing the bone with manipulation. Use standing X-rays preoperatively, with the patient allowing the arch to collapse. [SIZE=3]Keep in mind that I'm only a coding student, but I hope the codes I found at least point us in the right direction. Note: Any of these options may help symptoms and possibly slow down progression, but they do not halt progression. At the 10-16 week mark, the patient can then transition into a shoe. doi: 10.1016/j.cpm.2004.11.002. Make sure that the fit is good. Federal government websites often end in .gov or .mil. With the thin oscillating saw, make the osteotomy perpendicular to plantar aspect of the foot just distal to the K-wire into the medial cortex. 2001 Jul-Aug;139(4):332-9. doi: 10.1055/s-2001-16920. 26.4). 8600 Rockville Pike document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); The Relief Institute All surgeons have different protocols so patients must follow the protocol of their specific provider. Calcaneal osteotomy in the treatment of adult acquired flatfoot deformity. The lateral column lengthening procedure provides a powerful correction in patients with flatfoot foot deformities, however, though it is a procedure with clear advantages, there are also potential disadvantages. 26.1 ). The depth of the saw cut can be marked on the saw with a marking pen. 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. A lateral column lengthening procedure is a very powerful procedure, since it can dramatically change the shape of the foot. A Modified Extra-articular Lateral Column Lengthening Procedure for Adult Acquired Flatfoot Deformity Show all authors. We performed a retrospective radiographic review and looked at 11 consecutive cases of patients who underwent hindfoot arthrodesis with a lateral column lengthening procedure. Careers. Disclaimer, National Library of Medicine 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. Unable to passively bring the talonavicular joint into an adducted or inverted position. A lateral column lengthening, also called a calcaneal lengthening or Evans osteotomy, helps improve the positioning of the foot. Click here to view our full disclaimer. HHS Vulnerability Disclosure, Help This site needs JavaScript to work properly. Frisco, TX 75034 The doctor prescribes the patient medication to manage the postoperative pain and schedules follow up visits. Volkering C, Erne H, Altenberger S, Walther M. Orthopade. 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. Posterior tibial tendon (PTT) dysfunction. 26.1.4 Contraindications Subscribe to. Only gold members can continue reading. J Foot Ankle Surg. In adults, however, lengthening leads to calcaneocuboid arthritis. Arthrex offers multiple implant options for lateral column lengthening procedures including the BioSync titanium porous wedges or the AlloSync allograft wedges. 8600 Rockville Pike the CPT codes tracked to each defined case category. This site needs JavaScript to work properly. 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. doi: 10.1016/j.cpm.2007.07.002. These findings demonstrate the need for clinical investigation of this procedure, which could preserve motion in the talonavicular and subtalar joints, correct deformity, and obviate calcaneocuboid arthritis. This pushes the foot into a straighter position. The .gov means its official. I did google it though, and came up with a couple sites that used the same code. Dissect at the midportion of the incision to find the floor of the sinus tarsi, taking care to avoid and stay above the peroneal tendons and sural nerve. These codes all show Osteotomy so I am confused. 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. Log In or Register to continue This is helpful to assess possible lateral impingement at the subtalar joint and subfibular impingement. Rammelt S, Zwipp H, Schneiders W, Heineck J. Eur J Trauma Emerg Surg. 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. LRR can be performed as an isolated procedure or as an associated procedure. Sensitivity of plantar pressure and talonavicular alignment to lateral column lengthening in flatfoot reconstruction. Achilles lengthening (CPT 27685) - as you. The surgeon then cuts the outside of the heel bone and inserts a trapezoidal shaped bone graft into the lateral column. Allograft bone avoids donor site morbidity of autogenous iliac crest grafts and was not shown to increase rates of nonunion. Please enable it to take advantage of the complete set of features! Level of Clinical Evidence: 4; dysfunction; medial; osteotomy; posterior; tendon; tibial. Progressive Flatfoot (Posterior Tibial Tendon Dysfunction) The optimal method to avoid violating the subtalar joint during lateral column lengthening remained controversial in published reports, implying that the subtalar joint might . The graft places pressure on the foot and brings the foot into a straighter position. Hallux elevatus 269 Chestnut St. #271 Effects of surgical correction for the treatment of adult acquired flatfoot deformity: a computational investigation. J Foot Ankle Surg. Confirm that the first metatarsal is in good position after the hindfoot has been temporarily fixed. Debridement posterior tibial tendon tear Bethesda, MD 20894, Web Policies The foot and ankle surgeon also prescribes the patient a physical therapy protocol. 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. official website and that any information you provide is encrypted and transmitted securely. 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. Fashion the graft according to the ideal amount of correction as shown by looking at the osteotomy held open to the desired amount. 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. I'm new to foot surgeries so this was helpful. 26.4). 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. Therefore, the lateral column lengthening procedure involves lengthening this region. The wedge is usually trapezoidal in shape. Bethesda, MD 20894, Web Policies 26.1.2 Radiographic Evaluation Correction of the deformity should be judged not only radiographically but also clinically. View any code changes for 2023 as well as historical information on code creation and revision. After lateral column lengthening with calcaneocuboid fusion, 48% of talonavicular and 70% of subtalar joint range of motion were preserved. Place a pin distractor with one pin right next to the calcaneocuboid joint and the other well posterior to the saw cut. Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. Epub 2013 Jan 10. Foot Ankle Int. Do you have flat feet or fallen arches? Oh I, Imhauser C, Choi D, Williams B, Ellis S, Deland J. J Bone Joint Surg Am. Lateral column lengthening for acquired adult flatfoot deformity caused by posterior tibial tendon dysfunction stage II: a retrospective comparison of calcaneus osteotomy with calcaneocuboid distraction arthrodesis. government site. The Current Procedural Terminology (CPT ) code 28300 as maintained by American Medical Association, is a medical procedural code under the range - Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes. 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. Lateral column lengthening with calcaneocuboid fusion, which lengthens the lateral column of the foot and prevents calcaneocuboid arthritis, was investigated in a cadaver model to determine the remaining range of motion in the talonavicular and subtalar joints. Lateral column lengthening using allograft tricortical iliac crest bone graft with cervical plate fixation is a viable option for the correction of acquired pes planovalgus deformity. Lateral column lengthening is a useful adjunct to hindfoot arthrodesis in the correction of revision and severe end-stage flatfoot deformity. 2003 Sep;8(3):539-62. doi: 10.1016/s1083-7515(03)00082-2. Please enable it to take advantage of the complete set of features! Medial-sided bony procedures: why, what, and how. Clinically, there should be near-normal eversion motion remaining, but mild stiffness is acceptable (Fig. FOIA 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 isn't correct. 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. Hold the osteotomy open to the desired amount of lengthening and fashion a tricortical allograft to fit that space. 2010 Jul-Aug;49(4):380-4. doi: 10.1053/j.jfas.2010.04.023. Zhou H, Ren H, Li C, Xia J, Yu G, Yang Y. Biomed Res Int. 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. 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. Fill out the form below and we will call you back. 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. Tendon lenghtening with osteotomy 27685 28200 osteotomy tendon lengthing, Arthrex Interna Brace reconstruction for pes plano valgus deformity arthrex brace flat foot ligament reconstruction podiatry spring ligament, help with surgery please identified incision joint screws tissue, Clubfoot DeformitiesGet a Full Range of Understanding. However, it involves the risk of damaging articular facets of the subtalar joint. 26.6 Operative Technique 2010 Jul-Aug;49(4):380-4. doi: 10.1053/j.jfas.2010.04.023. Deep dissection was performed by spreading and cutting with a pair of Converse scissors and the lateral wall of the calcaneus was identified. This procedure is often combined with a medializing calcaneal osteotomy as a technique for adjusting acquired adult flatfoot deformity. Effect of variations in calcaneocuboid fusion technique on kinematics of the normal hindfoot. Would you like email updates of new search results? Correct alignment so that each of the following is achieved: Orthopedic foot and ankle surgeons may perform a lateral column lengthening if the patient suffers from a flat foot or foot that rotates outward. 26.5). 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. Use standing X-rays preoperatively, with the patient allowing the arch to collapse. The lateral column lengthening procedure provides a powerful correction in patients with flatfoot foot deformities, however, though it is a procedure with clear advantages,there arealso potential disadvantages. The successful patient has near-normal eversion motion remaining in the hindfoot, and good alignment of the heel. Also, look for possible sags at naviculocuneiform and first tarsometatarsal joints on the standing lateral X-ray. 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. 26.6.1 Lateral Column Lengthening: Evans Procedure Use a sinus tarsi incision extending from the tip of the fibula to the anterior process of the calcaneus ( Fig. Thank you Plaidman. Therefore, the lateral column lengthening procedure involves lengthening this region. Another method (my preferred method) is to use trial wedges in 1-mm increments or some instrument with the desired amounts of lengthening to judge the foot.1 Use the wedges or instrument inserted into the osteotomy to judge the correction. One way of performing this procedure is by cutting the bone (osteotomy) through the front part of the calcaneus. 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. Calcaneocuboid distraction arthrodesis and first metatarsocuneiform arthrodesis for correction of acquired flatfoot deformity in a cadaver model. MeSH Lateral column lengthening is a powerful procedure performed either with an Evans calcaneal osteotomy or calcaneocuboid distraction arthrodesis that can be used as an adjunct in realigning the flatfoot. Before government site. 8600 Rockville Pike Accessibility The incision was carried down through the skin only with a #15 blade knife. Dissect laterally over the anterior calcaneus, from a point adjacent to the calcaneocuboid joint to the level of the posterior facet. We matched these patients with 11 control patients who underwent isolated medial-approach double arthrodesis. 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 aspainful hardware,sural nerve irritation, andnonunion. When sleeping, the heel of the surgical foot should always remain off of the bed. Curr Rev Musculoskelet Med. Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study. Posterior calcaneal displacement osteotomy for the adult acquired flatfoot. Weaken the medial cortex so that the osteotomy can be hinged open with an osteotome (Fig. 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. He gives me 28297, 28310, and 28308. MeSH MeSH The patient must not be so collapsed in the triple joint complex that the foot cannot be tensioned by an LCL to accomplish good position of the talonavicular and subtalar joints when the patient stands. The site is secure. Clinical and radiological results. Ritchie (ankle-level hinged brace with plantar orthotic component). Bethesda, MD 20894, Web Policies Lateral retinaculum is an important stabilizer of patella, and the role of lateral retinacular release (LRR) for patellar instability is controversial. HSS J. Patient is positioned supine. Too much correction can result in a good-looking X-ray and no impingement, but the hindfoot still too stiff. However, full recovery can take up to 18 months. Surgical Procedure Condition or Diagnosis Subjective Objective Imaging Non-operative care Medial Cuneiform Osteotomy Lateral Column Lengthening worsened by Kidner Procedure valgus and pes planus posture of the foot, this condition does not arise from and is not cumulative weight bearing in the workplace Tarsal Tunnel Release Tarsal tunnel This procedure is utilized to address the plantarmedial subluxation of . In cases with more than a little increased heel valgus, it is normally necessary to do a posterior calcaneal osteotomy as well as an LCL to obtain correct position of the heel. This correction effectively negates the loss of normal biomechanics created by the loss of the dynamic function of the posterior tibial tendon. The surfaces were osteotomized to expose cancellous bone and remove the surfaces. P preserene Guest Messages AlloSync Evans Wedge, 18 mm x 18 mm x 6.5 mm, AlloSync Evans Wedge, 18 mm x 18 mm x 8 mm, AlloSync Evans Wedge, 18 mm x 18 mm x 10 mm, AlloSync Evans Wedge, 18 mm x 18 mm x 12 mm, AlloSync Evans Wedge, 20 mm x 20 mm x 6.5 mm, AlloSync Evans Wedge, 20 mm x 20 mm x 8 mm, AlloSync Evans Wedge, 20 mm x 20 mm x 10 mm, AlloSync Evans Wedge, 20 mm x 20 mm x 12 mm, AlloSync Evans Wedge, 22 mm x 22 mm x 6.5 mm, AlloSync Evans Wedge, 22 mm x 22 mm x 8 mm, AlloSync Evans Wedge, 22 mm x 22 mm x 10 mm, AlloSync Evans Wedge, 22 mm x 22 mm x 12 mm, Plate, Low Profile, Cotton, Titanium, Flat, Plate, Low Profile, Cotton, Titanium, 2 mm, Plate, Low Profile, Cotton, Titanium, 4 mm, Plate, Low Profile, Cotton, Titanium, 6 mm, Plate, Low Profile, Cotton, Titanium, 8 mm, 04:35 | English | 05/10/2017 | VID1-00914-EN B, 04:27 | English | 12/27/2016 | AN1-00175-EN C, 04:00 | English | 07/23/2020 | VID1-000741-en-US A, 02:04 | English | 10/15/2018 | pAN1-00175-EN A, Lateral Column Lengthening (Evans Osteotomy). PMC 2001 Mar;6(1):95-119. doi: 10.1016/s1083-7515(03)00083-4. JavaScript is disabled. You are using an out of date browser. If your accounts receivables are higher than expected in first quarter 2017 remember the old adage If it8217s too good to be true it probably is. Federal government websites often end in .gov or .mil. 1999 Nov;81(11):1545-60. doi: 10.2106/00004623-199911000-00006. With the graft in place and pinned, confirm that the amount of correction is appropriate and that both clinical inspection and fluoroscopic views show good apposition of the graft to the native bone. 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. Background:Lateral column lengthening (LCL), originally described by Evans, is an established procedure to correct stage II adult acquired flatfoot deformity (AAFD). registered for member area and forum access. A lateral column lengthening procedure is a very powerful procedure, since it can dramatically change the shape of the foot. This procedure is often combined with amedializing calcaneal osteotomy, (often referred to as the All American procedure), as a technique for adjustingacquired adult flatfoot deformity. Disclaimer, National Library of Medicine Related government site. Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT code. In cases with more than a little increased heel valgus, it is normally necessary to do a posterior calcaneal osteotomy as well as an LCL to obtain correct position of the heel. Confirm that the heel alignment is good after temporary fixation of the LCL and the posterior calcaneal osteotomy. Use a sinus tarsi incision extending from the tip of the fibula to the anterior process of the calcaneus (Fig.

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