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Replacement Metatarsal, Right to No Qualifier with Synthetic Substitute, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | Q Lower Bones |
| Operation | R Replacement |
| Body Part | N Metatarsal, Right |
| Approach | 0 Open |
| Device | J Synthetic Substitute |
| Qualifier | Z No Qualifier |
Operation Definition
Putting in or on biological or synthetic material that physically takes the place and/or function of all or a portion of a body part
Procedure Overview
Replacement procedures put in biological or synthetic material that physically takes over the role of all or part of a lower bone. This includes structural bone grafts, cadaver bone allografts, and synthetic bone substitutes used to rebuild a portion of the pelvis, femur, tibia, fibula, or foot bones after tumor resection, severe trauma, or bone loss from infection.
These procedures are performed when a segment of bone is missing or so damaged that it can no longer support the body's structure or function on its own, and simply repairing or repositioning the remaining bone isn't enough. A patient who has had a tumor removed from the femoral shaft, for example, may need the resulting gap filled with a structural allograft to restore the bone's load-bearing capacity.
Anatomy & Axis Detail
Metatarsal, Right
The metatarsals of the right foot are the five long bones connecting the tarsus to the toes, bearing significant load during the push-off phase of gait, with the first metatarsal in particular supporting a disproportionate share of forefoot weight. Replacement of a metatarsal is uncommon and is generally performed after tumor resection, severe traumatic bone loss, or advanced destruction from infection, using a prosthetic implant or structural graft sized to the specific ray involved to preserve forefoot length and the transverse metatarsal arch. Because shortening or malalignment of even one metatarsal can transfer abnormal load to adjacent rays and cause painful transfer lesions, reconstructive length and alignment are prioritized, and the specific metatarsal replaced should be documented given the differing biomechanical demands placed on the first ray versus the lesser metatarsals.
Approach: Open
Open approach means the surgeon cuts through skin, mucous membrane, or other tissue layers to physically expose the target site to view before performing the procedure. It gives direct visualization and hands-on access, distinguishing it from Percutaneous approaches where instruments pass through a small puncture without exposing the site. Open is typical for procedures needing wide access, such as most laparotomies.
Device: Synthetic Substitute
Synthetic Substitute designates a device made from manufactured, non-biologic material, such as mesh or prosthetic components, used to replace or augment a body part. It is distinguished from the two tissue substitute categories by its artificial composition, which carries different considerations for integration and long-term durability than biologic grafts.
Coding & Documentation
Documentation must describe material being put in that takes over the physical role of the bone segment - not material that merely reinforces existing bone, which would be Supplement instead. The type of graft or substitute material and the specific bone segment addressed both need to be clear in the operative note. A frequent error is coding Replacement when bone graft is used to fill a defect but the native bone structure is still largely intact and functional, which points toward Supplement rather than Replacement; another is confusing joint replacement procedures, which are coded to the Lower Joints body system, with bone-segment replacement coded here.