Answer Extensor Hallucis Longus Tenolysis and Lengthening CPT?

cclarson

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Hello Everyone,

The doctor performed a EHL tenolysis while also z-lengthening the tendon. I'm a little lost as to how to code this. I was looking at 28225 for the tenolysis portion of the procedure? There was also an implant removal, but I know that would be bundled into the main procedure. Any help would be deeply appreciated, thank you.

Here is the op note:

POSTOPERATIVE DIAGNOSES:
1. Right hallux extensor hallucis longus tendon contracture.
2. Painful retrained hardware right foot.

OPERATION PERFORMED:
1. Right foot extensor hallucis longus tenolysis with tendon lengthening.
2. Removal of deep hardware right foot (screw).

INDICATIONS FOR PROCEDURE:
The patient is a 68-year-old female status post a right hallux MTP arthrodesis with revision, who has developed contracture of the right hallux with pain with retrained hardware.

DESCRIPTION OF PROCEDURE:

The patient had the right lower extremity marked. Appropriate consent was obtained, transported to the operating room, placed in the supine position on the operating table, sedated and intubated per anesthesia. The patient underwent an ankle block per anesthesia. The right foot was then prepped and draped in a sterile fashion. Timeout was taken. Proper identify, extremity, and procedure were confirmed. The tourniquet was inflated to 300 mmHg.

A dorsal longitudinal incision was extended over the dorsal aspect of the hallux in line with a well-healed scar. This was carried through skin and subcutaneous layers deep to the level of the extensor hallucis longus tendon. The tendon was split longitudinally and then Z-lengthened. Surrounding fibrous tissue was debrided off of the tendon to loosen it from the contracture. Dissection was then carried along the medial side of the hallux near the interphalangeal joint. Screw head was identified. Bone was debrided from around the screwhead. A screwdriver was then used to extract the screws from the distal end of the proximal phalanx.

Once the screw was fully removed, dissection was carried over the fusion site along the lateral portion of the metatarsal head. There was no prominence encountered at the site of the patient’s pain. There appeared to be a full union at her fusion site. The tendon was then repaired in a lengthened position with 2-0 Vicryl suture interrupted fashion. The incision was then irrigated and then closed in a layered fashion with subcutaneous 3-0 Monocryl suture and 4-0 nylon suture in the skin. The incision was then covered with Xeroform dressing. 4x4 gauze, cast padding, and elastic bandage. The patient was then awakened, extubated, transported to Recovery in stable condition. At the end of the case all needle, sponge and instrument counts were correct.
 

Orthocoderpgu

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Code 28225 for the tenolysis is correct. The tendon lengthening z-tenotomy is going to bundle. However, this is a rare chance that you can also bill 20680 as well. If removing the hardware is necessary in order to perform a procedure it generally bundles, but that's not the case here. The tenolysis was completed and then the hardware was removed. Take advantage of this, you can bill both.
 

cclarson

Networker
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Location
Conway, SC
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Code 28225 for the tenolysis is correct. The tendon lengthening z-tenotomy is going to bundle. However, this is a rare chance that you can also bill 20680 as well. If removing the hardware is necessary in order to perform a procedure it generally bundles, but that's not the case here. The tenolysis was completed and then the hardware was removed. Take advantage of this, you can bill both.
I figured that the lengthening might bundle. And thank you for letting me know that I can do 20680! :)
 
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