Wiki Heterotopic ossification removal

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NorthstarCoder

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Trying to code removal of a heterotopic ossification on the greater trochanter. I'm planning on using 726.91 for a dx but unsure what CPT to use. :( Would this fall under an unspecified code(such as 27299) or is there a specific code for this? The descriptions for the other osteotomy codes don't seem to describe what was done, which was simply dissection down to the greater trochanter and excision of the heterotopic spike with an osteotome.


Any suggestions would be appreciated!
 
NorthstarCoder said:
Trying to code removal of a heterotopic ossification on the greater trochanter. I'm planning on using 726.91 for a dx but unsure what CPT to use. :( Would this fall under an unspecified code(such as 27299) or is there a specific code for this? The descriptions for the other osteotomy codes don't seem to describe what was done, which was simply dissection down to the greater trochanter and excision of the heterotopic spike with an osteotome.


Any suggestions would be appreciated!
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Unless the documentation says "partial"., I would start in the 27065 code range for this one.
 
In the grand scheme of things, Heterotopic Bone formation is usually the result of previous injury/trauma, which includes surgical procedures (which are a form of trauma to the tissues). As for the hip, the bone formation is usually within the hip muscles that attach to the Greater Trochanter (Gluteals/Abductors). The surgical procedure for its removal is the excision of the boney mass from that muscle. It is not a procedure on the trochanter itself. Therefore, for the CPT Code, there is none that describes this procedure exactly. I would recommend 27299: Unlisted Procedure for the hip, and pair it with 27045/8: Excision of Tumor, Soft Tissue of the Hip, Intramuscular, 5 cm +/- for the final digit. The other codes mentioned by others imply surgery being done to the trochanter itself, which this is not.
The Diagnosis Code mentioned is an ICD-9 code, not ICD-10. I don't know how you are going to get away with an ICD-9 Code at this time. I would look at M61.45 _: "Other" ossification of muscle.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 
Can excision of heterotopic ossification be billed separately from IT hand release and bursectomy or would it be considered inclusive? It was all performed through the same incision.
Thanks in advance for any help!

PREOPERATIVE DIAGNOSIS: 1. Left hip IT band syndrome 2. Left hip bursitis 3. Painful hardware left hip 4. Heterotopic bone left hip

PROCEDURE PERFORMED: 1. Open IT band release 2. Open bursectomy left trochanteric bursa 3. Removal painful heterotopic bone left femur

INDICATIONS: Patient has IT band syndrome and bursitis. He also has some rubbing of the sliding hip screw laterally with some heterotopic bone. After failure of conservative treatment patient wanted to proceed with IT band release bursectomy and removal of the heterotopic bone.

DESCRIPTION OF PROCEDURE: An incision overlying the greater trochanter was made through the skin subcutaneous tissue the IT band was identified split in line with its fibers. I then made a rectangular excision of the IT band overlying the trochanter. A bursectomy was then performed with a Bovie and rongeur. There was heterotopic bone prominent laterally which was removed with a rongeur and a rasp. I took the hip through range of motion there was no more rubbing on the remaining IT band. We irrigated closed the subcutaneous tissue with 0 Vicryl and 2-0 Vicryl sutures the skin with staples.
 
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