• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Endoscopic Achilles tendon repair

A

abarajas

Contributor
Messages
17
Location
Phoenix, AZ
Hello, any guidance or information on arthroscopic achilles tendon repair with haglunds lesion removal is really appreciated. This is the first time I see these procedures being done with the scope. Would I still use the open codes 27654 and 28118 or would it be unlisted 29999?
 
You might want to share an op note.

CPT/NCCI are clear - you cannot use an open code for an endoscopic procedure, so it would be unlisted. If it is endoscopic-assisted and largely open, you can easily get away with the open code, but would likely recommend talking to your surgeon about tweaking how he or she describes the procedure to ensure you don't get denials

Also, you want to be precise - there was no joint, the achilles is extraarticular, so it is not arthroscopic, it is endoscopic.
N.
 
NRaizman said:
You might want to share an op note.

CPT/NCCI are clear - you cannot use an open code for an endoscopic procedure, so it would be unlisted. If it is endoscopic-assisted and largely open, you can easily get away with the open code, but would likely recommend talking to your surgeon about tweaking how he or she describes the procedure to ensure you don't get denials

Also, you want to be precise - there was no joint, the achilles is extraarticular, so it is not arthroscopic, it is endoscopic.
N.
Click to expand...

Good morning. Here is the procedure performed section and the body of the op report.

PROCEDURES PERFORMED: Arthroscopic debridement and repair of Achilles tendon with excision of Haglund's lesion. 27654 28118

DESCRIPTION OF PROCEDURE: The patient was brought back to the operative suite and placed under anesthesia in a standard fashion. A well-padded tourniquet was placed on the left upper thigh. The patient was placed in the prone position with all bony prominences well padded. The left leg was prepped and draped in the usual sterile fashion. A time-out was performed. Gravity exsanguination was used and a tourniquet was elevated to 250 mmHg. I began by making four individual portals based on fluoroscopic imaging. Then, using an MIS bur, I resected the Haglund's lesion in its totality and the insertional enthesophyte. To note, the patient did have calcific tendinopathy of the tendon, which was known, and so some of this was still present. We did debride the underside of the tendon using a curette and a rongeur. At this point, I began the repair. I drilled and tapped all four portals. I placed the two proximal screws and suture anchors. Using an in-out-in pass-through and rip-stop technique, I secured the proximal tendon. I then brought these sutures out through the distal portals. I then put these through the two other suture anchors and I drilled and tapped these, essentially making a double-row repair. I cut the sutures short. I checked every anchor, and every anchor was secure and the tendon repair was secure. Therefore, I irrigated. I closed the portal wounds and a splint was applied
 
NRaizman said:
Yep. The above guidance holds - this has to be an unlisted procedure. I would talk to your surgeon about changing the way he dictates the procedure.
Click to expand...
CPT 27650 and 27652 are primary repairs and include "percutaneous" in the description. Because the scope is being used then this would not fall under that correct?
 
You must log in or register to reply here.
Top