06/12/2017

Billing for Achilles Tendonopathy (Partial Tears), Haglund’s Deformity and Posterior Heel Spur Resection

A patient is taken to the OR for Achilles tendonopathy with partial tears, a Haglund's deformity and a posterior heel spur. The haglund's deformity is resected, the posterior heel spur is resected and the Achilles tendon is primarily repaired. What would be the correct way to bill for the services performed?

Bill CPT 27650

Code Description

27650: Repair, primary, open or percutaneous, ruptured Achilles tendon;

Lay Description (Code):

The physician repairs a ruptured Achilles tendon. An incision is made overlying the tendon. The physician extends the incision through the tissues to the tendon. The physician identifies the tear and debrides any rough edges. In 27652, the physician harvests a fascial graft from the patient through a separate incision. The physician repairs the surgically created graft donor site. The graft is incorporated into the repair of the tendon and secured to the area with fixation (e.g., screw). The tendon is repaired, typically with a heavy nonabsorbable suture. The wound is irrigated with antibiotic solution and closed in layers. A cast, splint, or brace may be applied.

Coding Tips:

In 27652, any tendon graft harvest is not reported separately. Primary repair codes report the initial repair of a current or acute injury. For secondary repair, with or without a graft, see 27654. According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure. See "Application of Casts and Strapping" in the CPT book in the Surgery section, under Musculoskeletal System.

Bill CPT 28119

Code Description:

28119: Ostectomy, calcaneus; for spur, with or without plantar fascial release

Lay Description (Code):

The physician applies a tourniquet to the ankle. The medial third of the plantar fascia is incised and, through the incision, the abductor hallucis muscle is elevated and a portion of the deep fascia of the abductor hallucis released, if required. To excise the spur, a key elevator is placed forward and back of the spur and the spur is transected with an osteotome. The cut spur is removed using a rongeur and the bone edges smoothed. Thrombin or bone wax can be packed at the cut edge of the bone. In some cases, part of the flexor digitorum brevis must be removed for a calcaneal spur that is deeply embedded. Once the spur is removed, the margins are smoothed with a bone rasp. The wound is irrigated and a dressing is applied.

Coding Tips:

According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure. See "Application of Casts and Strapping" in the CPT book in the Surgery section, under Musculoskeletal System. For excision of a tarsal coalition involving the calcaneus, see 28116. For other calcaneus ostectomy, see 28118. For radiology services, see 73600-73660.