Orthopedic Coding Alert

Question: The surgeon completed a modified Brostrom repair with repair of the peroneus brevis ligament. It appears that he only repaired the lateral side. I think the correct code is 27696, but don't completely understand the descriptor. Does "both ligaments" mean medial and lateral ligaments, or can it mean more than one lateral ligament?

Idaho Subscriber

Answer: Many coders interpret the phrase "bothcollateral" in 27696's descriptor to mean medial and lateral ligaments instead of multiple ligaments on the same side. Code 27696 (Transfer or transplant of single tendon [with muscle redirection or rerouting]; both collateral ligaments]), however, is not your best choice in this case. The more accurate code for the procedure you describe would be either 27698 (Repair, secondary, disrupted ligament, ankle, collateral [e.g., Watson-Jones procedure]) or 27659 (...secondary, with or without graft, each tendon).

Explanation: An orthopedist generally performs a Brostrom repair after longstanding ligament instability, not a recent injury. That makes the Brostrom a secondary repair. In addition, the peroneus brevis is a tendon, not a ligament.

Future reference: The lateral collateral ligaments include the anterior talofibular, calcaneofibular, and the posterior talofibular. The medial collateral ligaments (which are often called the deltoid ligaments) include the tibionavicular, calcaneotibial, anterior talotibial, and posterior talotibial.