Carol E
Contributor
Question for Ortho experts:
How would you approach coding the following orthopedic surgery?
Would you report CPT 29898 (ankle arthroscopy extensive debridement) separately when performed alongside a Broström procedure (27698)? Additionally, if peroneal tenosynovectomy is performed on both the brevis and longus tendons, would you report CPT 27680 twice in addition to the Brostrom? Any authoritative sources or articles to support your coding choices would be greatly appreciated! I've pasted the full op report below.
POSTOPERATIVE DIAGNOSES:
1. Left ankle anterior impingement.
2. Left ankle chronic lateral ligamentous insufficiency with instability.
OPERATIONS PERFORMED:
1. Left ankle arthroscopy with extensive debridement.
2. Left ankle modified Brostrom lateral ligament reconstruction.
3. Tenosynovectomy of peroneal tendon, left.
ANESTHESIA: General plus local. TOURNIQUET TIME: Approximately 50 minutes. ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None. DISPOSITION: To PACU in stable condition.
INDICATIONS FOR PROCEDURE: The patient is a 19-year-old male with history of recurrent left ankle injuries with residual symptoms consistent with the above that have been refractory to multiple conservative measures, he was therefore, offered the above procedure, with the understanding that the operative risks include, but are not limited to bleeding, infection, damage to adjacent structures, continued pain, recurrent symptoms, stiffness, weakness, recurrent instability, deep venous thrombosis, pulmonary embolism, anesthetic complication, wound dehiscence, need for further procedures, and traumatic arthropathy. He voiced his understanding, agreed, and the operative consent was signed.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative holding area by myself and the Anesthesia. He was taken to the operating room and placed in supine position on the operating room table. At this point, general anesthesia was initiated. A time-out was called completed. He received appropriate intravenous antibiotics. Once prepped and draped, the extremity was exsanguinated and tourniquet was inflated. About, 0.5% ropivacaine was placed in the field block around the fibula as well as the ankle joint, 20 mL total. Prior to prepping and draping, the left lower extremity was placed in the leg holder for noninvasive ankle distraction. Once prepped and draped and once the extremity was exsanguinated and tourniquet was inflated. Anteromedial and anterolateral ankle arthroscopy portals were then created with nick and-spread technique. Diagnostic arthroscopy was then performed with small joint arthroscope. There are areas of soft tissue impingement and synovitis in the anteromedial and anterolateral joint spaces. All this was debrided extensively with a small joint resector as well as the biter. The cartilage was in good condition throughout. There was significant instability. The ankle was taken out of the distraction. A small incision was made over the distal fibula. Dissection was taken down to the underlying subcutaneous tissue. The extensor retinaculum was identified and lifted up and preserved. The anterolateral ankle capsule and lateral ligament complex was thickened and lax, it was lifted up sharply off the distal fibula and debrided slightly. The underlying bone of the distal fibula was roughened up with a rongeur. A 2.9 mm PEEK anchors were placed x2 in the fibula in the origin of the lateral ligament complex using standard AO technique. The sutures from these anchors were then used to repair back the entire lateral ligamentous complex using a mattress stitch type technique. Sutures were tied down with ankle held in neutral dorsiflexion and slight eversion. The entire repair site was then oversewn with extensor retinaculum using #0 Vicryl suture placed in pants-over-vest and figure-of-eight fashion. Good stability was noted. Good restoration of the lateral ligament instability was noted without any loss of motion. Tenosynovectomy was performed of the peroneus brevis and peroneus longus tendons. Wounds were irrigated and closed with Vicryl and Monocryl. Sterile compressive dressing was applied along with well-padded splint. He tolerated the entire procedure well, and there were no complications.
How would you approach coding the following orthopedic surgery?
Would you report CPT 29898 (ankle arthroscopy extensive debridement) separately when performed alongside a Broström procedure (27698)? Additionally, if peroneal tenosynovectomy is performed on both the brevis and longus tendons, would you report CPT 27680 twice in addition to the Brostrom? Any authoritative sources or articles to support your coding choices would be greatly appreciated! I've pasted the full op report below.
POSTOPERATIVE DIAGNOSES:
1. Left ankle anterior impingement.
2. Left ankle chronic lateral ligamentous insufficiency with instability.
OPERATIONS PERFORMED:
1. Left ankle arthroscopy with extensive debridement.
2. Left ankle modified Brostrom lateral ligament reconstruction.
3. Tenosynovectomy of peroneal tendon, left.
ANESTHESIA: General plus local. TOURNIQUET TIME: Approximately 50 minutes. ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None. DISPOSITION: To PACU in stable condition.
INDICATIONS FOR PROCEDURE: The patient is a 19-year-old male with history of recurrent left ankle injuries with residual symptoms consistent with the above that have been refractory to multiple conservative measures, he was therefore, offered the above procedure, with the understanding that the operative risks include, but are not limited to bleeding, infection, damage to adjacent structures, continued pain, recurrent symptoms, stiffness, weakness, recurrent instability, deep venous thrombosis, pulmonary embolism, anesthetic complication, wound dehiscence, need for further procedures, and traumatic arthropathy. He voiced his understanding, agreed, and the operative consent was signed.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative holding area by myself and the Anesthesia. He was taken to the operating room and placed in supine position on the operating room table. At this point, general anesthesia was initiated. A time-out was called completed. He received appropriate intravenous antibiotics. Once prepped and draped, the extremity was exsanguinated and tourniquet was inflated. About, 0.5% ropivacaine was placed in the field block around the fibula as well as the ankle joint, 20 mL total. Prior to prepping and draping, the left lower extremity was placed in the leg holder for noninvasive ankle distraction. Once prepped and draped and once the extremity was exsanguinated and tourniquet was inflated. Anteromedial and anterolateral ankle arthroscopy portals were then created with nick and-spread technique. Diagnostic arthroscopy was then performed with small joint arthroscope. There are areas of soft tissue impingement and synovitis in the anteromedial and anterolateral joint spaces. All this was debrided extensively with a small joint resector as well as the biter. The cartilage was in good condition throughout. There was significant instability. The ankle was taken out of the distraction. A small incision was made over the distal fibula. Dissection was taken down to the underlying subcutaneous tissue. The extensor retinaculum was identified and lifted up and preserved. The anterolateral ankle capsule and lateral ligament complex was thickened and lax, it was lifted up sharply off the distal fibula and debrided slightly. The underlying bone of the distal fibula was roughened up with a rongeur. A 2.9 mm PEEK anchors were placed x2 in the fibula in the origin of the lateral ligament complex using standard AO technique. The sutures from these anchors were then used to repair back the entire lateral ligamentous complex using a mattress stitch type technique. Sutures were tied down with ankle held in neutral dorsiflexion and slight eversion. The entire repair site was then oversewn with extensor retinaculum using #0 Vicryl suture placed in pants-over-vest and figure-of-eight fashion. Good stability was noted. Good restoration of the lateral ligament instability was noted without any loss of motion. Tenosynovectomy was performed of the peroneus brevis and peroneus longus tendons. Wounds were irrigated and closed with Vicryl and Monocryl. Sterile compressive dressing was applied along with well-padded splint. He tolerated the entire procedure well, and there were no complications.