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Wiki Achilles Repair 01472

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JWash618

JWash618

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Is ASA 01472 only for diagnosis of ruptured or torn achilles tendon?

I have an Achilles Repair with Graft but the diagnosis is Achilles insertion tendinitis. I notice that the RVG is specific to Ruptured Achilles tendon so I wanted to be sure!
 
It always unnerves me when they throw a diagnosis into a CPT or ASA code!

All three of the CPT codes for repair of the Achilles tendon cross to 01472 per the 2012 crosswalk. The last code 27654 does not specifically state "rupture" in it's CPT description, but is still crossed to 01472 by ASA. The description beneath this code in the crosswalk states "Repair, secondary, Achilles tendon, with or without graft." Of course the word secondary may bother you with this code. However, since all the repair codes (primary, secondary, ruptured and no mention of rupture) cross to the same ASA and since typically any work done on the achilles is done in the prone position (5 base units) I would feel comfortable using it even with the word rupture in the code description.
 
I should also have mentioned, that when a code seems inappropriate in this way, you can pull the operative note and more often than not, the provider has left out one or more diagnoses, or has gone with the pre-operative, rather than post-operative dx. There may actually have been a tear.
 
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