CPT ASST
Issue: May 2011
Pages: 9
Title: Coding Consultation: Questions and Answers
Body: Surgery: Musculoskeletal System
Question:The patient was diagnosed with retrocalcaneal bursitis and Haglund's deformity of calcaneus. An incision was made along the lateral aspect of the distal Achilles tendon and the tendon was reflected thereby exposing the calcaneus. The retrocalcaneal bursa was excised. Next, an osteotome was used to remove the Haglund's deformity down to the Achilles insertion. A rasp was used to ensure that there were no residual osseous spurs. Debridement of the necrotic area of the Achilles tendon was performed, and the incision was closed in layers with sutures. Is it appropriate to report CPT code 28120,Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus,for this procedure?
Answer:No.If a Haglund's deformity of the heel and retrocalcaneal bursa were removed, then code 28118,Ostectomy, calcaneus, should be reported. If additional work other than for exposure was performed on the Achilles tendon, then that service would be reported as 28200,Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon. If there is a spur on the bottom of the foot and a plantar fascial release is performed, then code 28119,Ostectomy, calcaneus; for spur, with or without plantar fascial release, would be reported instead of/in addition to 28118. Code 28120,Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus,is typically performed for an infection and not for an exostosis, and only if a partial excision of the heel is performed.
I use 28108 for exostosis