Question Denial for CPT 27650

twalls

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DX- Chronic Achilles tendinosis with partial tear
CPT - 27650
Debridement and
repair Achilles tendon. The tendon was entirely detached

through lengthening the incision proximally and, actually, in

both directions. The terminal portion of the tendon was left

attached to periosteum and fascial expansions laterally. The

deep surface of the tendon was identified. It was yellow and

somewhat chalky and quite thickened. This was debrided away

with a #10 blade back to a much better contour, re-anchored to

the calcaneus with Smith and Nephew 4.5 mm anchors x2 and

FiberWire laid down against the calcaneus very smoothly.

Peripherally, it was repaired with 3-0 Vicryl as deemed necessary.

The fascia was closed upon it with 3 and 4-0 Vicryl

and 4-0 nylon.

Received denial for 27650-indicating a secondary repair would be more appropriate- everything I find indicates a secondary repair is more complex- is there something else I would call this?
As always thank you for your input!
 

VoitChromy

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Primary repair states it is done when the repair is done within a few days of the year. Secondary repair states it is a repeat due to original done unsuccessfully or it’s re injured
 

podcoder70

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The terms "primary" and "secondary" are confusing. Here is a good article that explains https://www.apma.org/files/Coding Surgical Scenarios.pdf

These are your choices:
1) If the surgery was performed in the first 24 hours of injury then report, CPT 27650-Repair, primary, open or percutaneous, ruptured Achilles tendon.
2) If repair was performed more than 2 weeks after injury, then use CPT 27654-Repair, secondary, Achilles tendon, with or without graft
3) If the surgery was performed between 25 hours and 2 weeks then select either CPT 27650 or CPT 27652 for Delayed primary.

Clear as mud, right?
 

twalls

Networker
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The terms "primary" and "secondary" are confusing. Here is a good article that explains https://www.apma.org/files/Coding Surgical Scenarios.pdf

These are your choices:
1) If the surgery was performed in the first 24 hours of injury then report, CPT 27650-Repair, primary, open or percutaneous, ruptured Achilles tendon.
2) If repair was performed more than 2 weeks after injury, then use CPT 27654-Repair, secondary, Achilles tendon, with or without graft
3) If the surgery was performed between 25 hours and 2 weeks then select either CPT 27650 or CPT 27652 for Delayed primary.

Clear as mud, right?
Thank you very much! I appreciate the clarity :)
 
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