02/04/2020

Correct Coding for Repairing FHL and a Z Lengthening of FHL Posterior to Ankle

Pt stepped on glass and lacerated her plantar fascia, FHL and FDL tendons. I am going to repair the FHL primarily and do a Z lengthening of the FHL posterior to the ankle . How do I code this please?

CPT 28200 can be utilized and that covers both the repair and lengthening of the FHL, since it is the same tendon.

Code Description

28200

Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon

Lay Description (Code):

If the tendon has ruptured, surgery may be required to repair the ruptured tendon or to replace it with a tendon graft. Usually, another tendon in the foot, such as the tendon that bends the four lesser toes is used as a tendon graft to replace the function of the posterior tibial tendon. In cases of a fixed flatfoot, the physician may perform a fusion (or arthrodesis) of the foot that requires the removal of a joint between two bones and the two bones on either side of the joint are allowed to grow together. This type of operation is used to stop pain from joints or to realign the bones. Several joints must be fused to control the flatfoot after a posterior tibial tendon rupture. Report 28202 if a free graft is used for the repair. The patient may be placed in a cast for six to eight weeks.

Coding Tips

Procedures 28200 and 28202 may be reported multiple times as these codes should be reported for each flexor tendon repair. When 28200 or 28202 is performed with another separately identifiable procedure, the highest dollar value code is listed as the primary procedure and subsequent procedures are appended with modifier 51. Harvesting of free tendon graft is included in 28202 and should not be reported separately. 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 the Musculoskeletal system.