Revenue Cycle Insider

Question: I want a second opinion for coding the following procedure:

Extensor digitorum longus (EDL) tendon released at midfoot and anchored into lateral cuneiform. Dorsal incision made and dissection down to tendon. Sharp release of the EDL and whip stitched together. Wire placed into cuneiform and drilled with 5.5 reamer to 20 mm. Placed tendon into the hole and pulled with fiber-wire to physiological tension and length. Locked with 4.75 bio-tenodesis. Lock stitch with fiber-wire performed. Noted nice tendon bone interface. Copiously irrigated and closed with 3-0/4-0 Monocryl.

The surgeon wants to bill 27691. I was leaning more toward code 27690. How should this be coded?

Maine Subscriber

Answer: The surgeon is correct in wanting to bill 27691 (Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)). CPT^® code 27691 is the better choice for this surgery because it involves releasing the tendon at the midfoot and attaching it to the cuneiform bone, which is exactly what was done in this procedure. Code 27690 (Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)) is typically used for freeing a tendon from adhesions, which is not the main focus of this particular surgery and would therefore be inappropriate in this scenario.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC