Wiki CPT for "Hibbs tenosuspension"

Create Wiki
S

solocoder

Expert
Messages
448
Location
Marshfield, MO
Best answers
0
I am needing a CPT code for this procedure. The description for 27690 says: procedure involves transfer or transplant of a single tendon from a number of different sites ON THE FOOT, but it is listed in the "leg and ankle" section of the coding companion book. So now I am confused. Any thoughts?


Attention was directed to the dorsal medial aspect of the right lateral cuneiform, where approximately 3 cm linear incision was made, lateral to the course of the dorsalis pedis artery. The incision was deepened in the same plane paying careful attention to preserve all the vessels and nerves which were retracted and cauterized as necessary. The dissection was carried down to the dorsal aspect of the lateral cuneiform.
*
The four tendon branches of the Extensor Digitorum Longus tendon were tenotomized distally, and using a fiberwire, the tendon ends were whip stitched, and passed through the tendon sizer, and it was noted to be 6 mm in diameter.
*
By using a proper instrumentation, 4.5 mm Arthrex Bio-Tenodesis Screw was used to insert the tendon into the dorsal aspect of the lateral cuneiform. The tendon was noted to be secured to the bone and it was noted to be stable. The distal ends of the tendon branches were sutured to the Extensor Digitorum Brevis tendons.
 
You do not give the Preoperative Diagnosis or the Preoperative Indications for the procedure, but my best guess is that the patient was not able to satisfactorily dorsiflex and/or evert his/her foot at the ankle. This procedure is to try to restore this active motion by using the tendons of the toe extensors (Extensor Digitorum Longus Tendons) and moving where they insert/attach to a foot bone (the Lateral Cuneiform). The Extensor Digitorum Longus Muscle is a muscle of the lower leg, even though the tendons insert/attach to and activate extension of the toes. Therefore, even though the procedure was done in the foot, the muscle used is in the lower leg; consequently the procedural code comes from the Leg and Ankle Joint CPT Code Set.

I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 
Thank you for your reply. No ankle problem was mentioned. Just "contracted extensor digitorum longus", causing contracture of the toe. Would this still be the correct code?
 
Last edited:
Dear Solocoder: This case has me completely baffled. I am not necessarily trying to "attack" your physician/surgeon for doing the procedure as described, but I am not sure why he chose this procedure for treatment of "toe contracture(s)." For a toe or toes contracture(s), most commonly extension of the MTP joint with resultant flexion the IP joints (i.e. claw toe(s) or hammer toe(s)), there are plenty of surgical procedure alternatives that I would think of doing first before doing a multiple tendon transfer such as was done in this case. Maybe your physician can give a better explanation as to what he was treating and why he chose this procedure.

By the way, the code you used is correct for the procedure he described in his Op Report.

If you get more information, please let me know.

Sincerely, Alan Pechacek, M.D.
icd10orthocoder.com

PS: I am not a "Guru."
 
You must log in or register to reply here.
Top