Excision of knee sinus tract/close to bursa

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AR2728

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Difficulty locating the appropriate CPT to describe the service performed....assistance is much appreciated! Hospital coder thought 27340 for bursa excision, however, I do not see where bursa was actually excised. Other suggestions located were excision of tumor codes to the knee area, although, operative report is really vague on details to code this appropriately.

Diagnosis: R knee septic prepatellar bursitis
Procedure: I&D with irrigation prepatellar bursa AND Right knee sinus tract excision

"An incision was made over the anterior aspect of the right knee and prior scar line from prior knee replacement surgery. Dissection continued down to prepatellar burse, no visible purulence in this area, gram stain and cultures taken. However, there was a sinus tract that went down from the skin towards the prepatellar burse, this was excised. The wound was curetted out. 6 L normal saline was used to irrigate wound, irrisept as well was used. Tourniquet let down.....#2 Proline suture used to close incision, dressing placed."
 
I definitely don't agree with coding for a bursectomy as the documentation doesn't state the bursa was excised. The documentation currently supports coding 27301 and 27327/27337 or 27328/27339. Depending on how deep the sinus tract went will determine how this is coded. If the sinus tract was excised from the subcutaneous tissue then this would be coded as 27301. This is because there's a CCI edit between 27301 and 27327/27337. However, if the sinus tract was excised from the subfascial tissue then this would be coded as 27328/27339. This is because there's a CCI edit between 27328/27339 and 27301. The documentation doesn't state the sinus tract was excised from a separate incision so we can't use a modifier 59 to unbundle these procedures. I would suggest querying your provider and asking if the sinus tract was excised from the subcutaneous or subfascial tissue as well as the size of the sinus tract (in cm). If you can't query your provider then I would code it as 27301 based on current documentation. Hope this helps!
 
Agree, most likely 27301. At first look it seems like 27340, difficult to tell from the documentation if they actually excised the bursa or just the sinus tract. But when you read closely, "down from the skin towards the prepatellar burse", it's clear no bursa was excised. The header says irrigation. Not the "greatest" documentation. If arthrotomy was done (not in this example above but common) it's 27310.
 
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