Haglund deformity with debridement of Achilles Tendon Calcifications


Jacksonville Beach, FL
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Any ideas on a code or codes to use for this?

Heres the meat of the op note. Thanks for any help!

A longitudinal incision was made on the anterior edge of the Achilles tendon. It was carried down the subcutaneous tissues. Care was taken not to violate the subcutaneous nerve structures. The anterior edge of the tendon was then peeled off the calcaneus, and I did this from lateral to medial all the way across the length of the calcaneus, and there was a deformed tubercle of the calcaneus with cauliflower looking appearance. At this point, I used the Freer elevator to elevate the tendon away from the bone and using the elevator as a protective device, I then used a saw to cut the tubercle of the calcaneus away.

Having completed this, I now used a reciprocal rasp to smooth, taper, and balance the cut that was made.

At this point, the tendon was palpated. There were multiple calcifications in the tendon, and I shelled these out leaving the tendon essentially intact.

Having completed this, I then irrigated copiously. I closed in layers utilizing 2-0 Vicryl and 3-0 PDS sutures. I injected with Marcaine for postoperative pain management, a bulky dressing was applied to the extremity, placed the patient in 90 degrees in the boot, and the tourniquet was deflated prior to this, 35 minutes.

Jamie Dezenzo

True Blue
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Per Marge Vaught

July 2007 Pink Sheet-

In order to access and remove the Haglund's, the orthopedist must split the Achilles tendon. The tendon is then repaired and reattached to the bone after the bone spur is excised. In many cases, the Achilles repair is an intrinsic compoment of the Haglund's osteotomy, and in these cases it would not be appropriate to report and Achilles tendon repair in addition to the bone removal.
However, if you have documentation that the tendon is thinned and compromesed, and that, as a result, additional work needs to be done to the tendon beyond the work involved in the osteotomy, the American Academy of Orthopaedic Surgeons, as well as the American Society of Podiatrists, say you have a case for reporting both procedures separately (27654 with modifier 59).

Select one of these codes for excision for the bone spur, depending on location:

28118 Ostectomy, calcaneus (small bump located at the back of heel)
28119 for spur, with or without plantar fascial release (bump located on bottom of heel)

28120 Partial excision (more extensive bone removal at back of heel)

Hope this helps :D