Wiki GASTROCNEMIUS RESECTION - Best Code to Use?

[cniland]

There is a debate in my office about how to code this procedure. This is a free-standing ASC. A DPM is doing the surgery. This is the entire part that is relevant to the procedure. I realize the note isn't very good. I spoke to the DPM about the procedure. The incision is being made in the lower (mid) calf. He says he slices the gastrocnemius tendon and it is a 5 minute procedure.

DESCRIPTION OF THE GASTROCNEMIUS RESECTION ON THE LEFT FOOT: A superficial skin incision was placed over the gastrocnemius tendon. This was done with superficial skin blade with sharp and blunt dissection deeply. The subcutaneous tissue was reflected back and was brought into view the gastrocnemius tendon which was noted and appreciated and transected in toto utilizing a #15 blade and Metzenbaum scissor. Once this was completed, the wound was then closed in layers utilizing 4-0 Polysorb in the subcutaneous tissue and the skin was closed with simple interrupted sutures of 4-0 nylon.

The DPM assured me it was 27612. I showed him the description of that code and he agreed that he isn't doing that procedure.

Based on the name of the procedure, it appears to be 27687. However, reading the description of 27687, I'm inclined to say it's NOT that code either. The doctor is for sure not doing the Strayer Procedure. Even still, that code appears to be much more involved. I did ask the doctor how deep he is going and it's about 1/2 inch. He isn't doing anything to the gastrocnemius muscle itself.

29999 would be used for a endoscopic gastrocnemius recession. And it's not endoscopic. However, I'm leaning towards this code because it seems the most appropriate as the other codes don't really seem to work in my opinion.

I will say it's difficult for us to get paid for unlisted procedures, so if there is a more appropriate code, I'd rather use that. I've been doing a lot of research and I'm not seeing anything that really fits this situation.

Any thoughts? Thank you in advance.

 

[meghanhannus]

Hello cniland,

I am thinking that the provider might have performed a tenotomy or tenolysis. I could not find any information on a gastrocnemius tendon as every definition states that is is a muscle. However, there are tendons that connect to gastrocnemius muscle that can become inflamed (tendonitis). I know that the tendon that attaches to the gastrocnemius is know as the calcaneal tendon (also know as Achilles tendon) which is located in the lower mid calf. Therefore I could see why the provider wanted to use a code for the Achilles tendon. I am thinking either CPT 27605 (local) or CPT 27606 (general) depending on local or general anesthesia since mentions skin/subcutaneous tissue? Or CPT 27680.


Hope this somewhat helps~

 

[cniland]

Thanks for the input.

I had the same problem finding out information for the Gastrocnemius tendon. When I probed the DPM about exactly where he was making an incision he replied - "I say right there, Gastrocnemius tendon." I wasn't able to find ANY info on that tendon either. I looked in my anatomy books, my boss is a RN and she also hadn't heard of it. The doctor says it is perpendicular (horizontal) to the Achilles and essentially holds the gastrocnemius muscles together in the lower calf. He pointed to the location in his leg and it's the lower mid calf, about 4 inches above the ankle.

I'm inclined to stay away from Achilles tendon codes, because the DPM assured me he wasn't touching the Achilles.(When I was researching the Gastrocnemius tendon I saw that it sometimes is referred to the Achilles and Calcaneal based on where it runs in the leg)

27680 is interesting. I think that could work.

Thank you so much for replying. I appreciate it.

 

[meghanhannus]

Thanks for the input.

I had the same problem finding out information for the Gastrocnemius tendon. When I probed the DPM about exactly where he was making an incision he replied - "I say right there, Gastrocnemius tendon." I wasn't able to find ANY info on that tendon either. I looked in my anatomy books, my boss is a RN and she also hadn't heard of it. The doctor says it is perpendicular (horizontal) to the Achilles and essentially holds the gastrocnemius muscles together in the lower calf. He pointed to the location in his leg and it's the lower mid calf, about 4 inches above the ankle.

I'm inclined to stay away from Achilles tendon codes, because the DPM assured me he wasn't touching the Achilles.(When I was researching the Gastrocnemius tendon I saw that it sometimes is referred to the Achilles and Calcaneal based on where it runs in the leg)

27680 is interesting. I think that could work.

Thank you so much for replying. I appreciate it.

You're welcome