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Resection Metatarsal-Phalangeal Joint, Right to No Qualifier with No Device, Open Approach
Procedural Specifications
| Clinical Axis | Detail Definition |
|---|---|
| Section | 0 Medical and Surgical |
| Body System | S Lower Joints |
| Operation | T Resection |
| Body Part | M Metatarsal-Phalangeal Joint, Right |
| Approach | 0 Open |
| Device | Z No Device |
| Qualifier | Z No Qualifier |
Operation Definition
Cutting out or off, without replacement, all of a body part
Procedure Overview
Resection in the lower joints means surgically removing an entire joint or joint structure without replacing it with any device. This is less common than joint replacement, typically reserved for severe infection that has destroyed a joint, a tumor requiring removal of the joint surfaces, or a salvage option after a failed implant cannot be replaced right away. A well-known example is resection arthroplasty of the hip, sometimes called a Girdlestone procedure, where the femoral head is removed and the space fills with scar tissue.
Because no artificial joint is inserted, patients typically have a shortened limb and altered mechanics, and mobility aids or later reconstruction may follow. This trade-off is usually accepted specifically to clear infection or malignant tissue threatening the limb.
Anatomy & Axis Detail
Metatarsal-Phalangeal Joint, Right
The right metatarsal-phalangeal joints, most clinically significant at the first toe, connect the metatarsal heads to the proximal phalanges and absorb substantial force during the push-off phase of walking. Resection removes the articular surface of the metatarsal head, the base of the proximal phalanx, or both, and is a classic approach to severe hallux rigidus, advanced hallux valgus with joint destruction, rheumatoid or gouty arthritis eroding the joint, or chronic infection such as a diabetic foot ulcer that has tracked into the joint. A resection arthroplasty of the first metatarsophalangeal joint, sometimes called a Keller procedure, deliberately shortens the toe and relies on fibrous scar tissue rather than an implant to form a mobile pseudojoint, distinguishing it from arthroplasty procedures that insert a prosthetic component.
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.
Coding & Documentation
A coder should look for documentation that the joint or a defined structure was entirely removed and nothing was implanted in its place; if a spacer or prosthesis went in during the same operation, the case likely calls for Replacement or a combination of codes instead of Resection alone. Infection control, pathology reports for malignancy, and prior failed hardware are common clinical justifications. The most frequent error is coding Resection when an antibiotic cement spacer was actually placed, since a spacer typically reclassifies the procedure as Replacement.