Wiki Can you "repair" the peroneal tendons by repairing the "retinaculum" ?

[Orthocoderpgu]

Can you "repair" the peroneal tendons by repairing the "retinaculum" ?

Patient had an ankle injury and the retinaculum over the peroneal brevis and longus was torn. The physician repaired the retinaculum which holds these down. However, the physician wants to bill for repair of dislocating tendon (27675) but in addition wants to bill for repairing the tendons themselves (27659) which I don't understand. He never did anything to repair the actual tendons, only repaired the retinaculum so they could stay in place. Would you allow an actual tendon repair for this?

If you are really good with ankle surgeries please don't hesitate to contact me with questions.

Thank you!

 

[nspell]

That's a good question! I believe your best reference would be to check your CPT book. If you look up both CPTs it should say 'do not use in conjunction with' and list a bunch of codes. If those 2 are not listed together you could bill them. If a code edit comes up on the billing scrubber of one being the component of the other, than yes I would remove it. The only way to bypass that edit would be with the XU modifier and that's for a non overlapping service. Since it's not for a separate non overlapping service you couldn't use the modifier, and therefor couldn't bill the code. So I would try that and go from there.

 

[hblakeman]

I don't have much experience in foot/ankle (we are getting a foot and ankle doc in the fall, so I've started to follow the podiatry board). I would be hesitant to code for the tendon repair. I would ask the physician what his or her reasoning is. I understand that repairing the retinaculum "fixed" the tendon problem, but if s/he didn't document any repair done to the tendon, I personally wouldn't code it. I'm curious what Dr. Pechacek's thoughts are.