By Paul Cadorette, CPC, CPC-H, CPC-ORTHO, CPC-P, CPC-ASC
You’re out in the yard and step into a hole. Your foot twists and you feel a pop and sharp pain in your ankle. This inversion or twisting motion of your foot happens frequently, only this time it caused an ankle sprain. With these ligaments injured, they are more susceptible to recurrent or continuous sprains leading to instability of the lateral or outside portion of your ankle.
There are three collateral ligaments found in this area, but it is the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) that we’ll focus on, as these are the ligaments most commonly associated with an inversion type injury. A preferred method of repair is a Brostrom procedure where one or both of the ligaments is sutured in an end-to-end fashion. Report this with CPT® codes 27695 Repair, primary, disrupted ligament, ankle; collateral for one collateral ligament and 27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments.
The Brostrom repair can also be over-sewn with the adjacent retinaculum to supplement and strengthen the repair in what’s called a Gould modification. Per the American Academy of Orthopaedic Surgeons, advancement of the retinaculum is considered part of the global service and not additionally reported. In code 27698 Repair, secondary, disrupted ligament, ankle, collateral (e.g., Watson-Jones procedure) for a secondary repair, the CPT® manual gives you an example of a Watson-Jones while Ingenix’ Coders’ Desk Reference mentions an Evans or Chrisman-Snook procedure. All of these procedures read more like a reconstruction instead of a repair in that the peroneus brevis tendon is transected at a more proximal location up the leg while remaining attached to its distal point on the fifth metatarsal tuberosity.
In an Evans procedure, the tendon is passed through drill holes in the fibula and secured. For the Chrisman-Snook, the tendon follows the same path as the Evans but then is brought down through drill holes in the calcaneus and sewn back onto itself in the area of the talus. The objective of these procedures is to anatomically replicate the position and function of the ATFL and CFL collateral ligaments.
So next time, you may not know exactly how you stepped down and twisted your ankle, but you’ll know how it can be repaired.