Wiki Hip Iliotibial Band Fasciotomy

[klbecker]

My physician performed a Hip Iliotibial band fasciotomy. The diagnosis is Greater Trochanteric bursitis. I'm torn between CPT code 27025 or 27299. I don't think this supports a 27305, as the incision and work was performed at the hip, not the knee. Please help!

The description of procedure is the following:
Patient was then placed lateral decubitus position, held in place with hip grip. The hip was prepped and draped in sterile fashion. The roughly 5 cm longitudinal incision was then made over the greater trochanteric area. The incision was taken down through subcutaneous tissue using electrocautery. The ITB band was entered longitudinally. The distal end was then released with curved Mayo scissors. Finger dissection was then used and 360 degree rotation to check for residual tight areas. Palpation of the greater trochanter revealed a cobblestone appearance, but there were still intact abductors. The posterior sleeve of the ITB band was significantly tighter than the anterior. The posterior edge of the ITB band were then released until the respective flaps of the ITB band were adequately relaxed....

Any answers/suggestions are greatly appreciated!

 

[amyjph]

What does the header say, and was anything else done at the same time (trochanteric bursectomy)?
It looks like 27025.

 

[klbecker]

Thank you for your response!

This is the rest of the information that's in the OP note. It does not mention anything else done at the same time. Only what I entered in my original question. No mention of trochanteric bursectomy. Would this still support a 27025?

POSTOPERATIVE DIAGNOSIS:
Greater trochanteric bursitis of right hip [M70.61]

OPERATION PERFORMED:
Procedure(s) with comments:
RIGHT HIP ILIOTIBIAL BAND FASCIOTOMY - Loosen tight band right hip

DESCRIPTION OF PROCEDURE and FINDINGS:
Indications: 70-year-old female who has had recurrent trochanteric bursitis of the right hip which has been recalcitrant to conservative methods. She has had good relief with prior cortisone injection, but problems have come back. She also has x-ray changes over the greater trochanter consistent with some early bone spurring and wear of the abductors.

 

[adunlap23]

Thank you for your response!

This is the rest of the information that's in the OP note. It does not mention anything else done at the same time. Only what I entered in my original question. No mention of trochanteric bursectomy. Would this still support a 27025?

POSTOPERATIVE DIAGNOSIS:
Greater trochanteric bursitis of right hip [M70.61]

OPERATION PERFORMED:
Procedure(s) with comments:
RIGHT HIP ILIOTIBIAL BAND FASCIOTOMY - Loosen tight band right hip

DESCRIPTION OF PROCEDURE and FINDINGS:
Indications: 70-year-old female who has had recurrent trochanteric bursitis of the right hip which has been recalcitrant to conservative methods. She has had good relief with prior cortisone injection, but problems have come back. She also has x-ray changes over the greater trochanter consistent with some early bone spurring and wear of the abductors.

I don't know, 27305 seems to describe exactly what is happening in the report. It doesn't specify that it has to be the knee region, it just indicates that it often contributes to knee tightness. According to Codify, 27025 includes debridement and is geared more towards release of the neurovascular structures in order to increase blood flow.

 

[klbecker]

I don't know, 27305 seems to describe exactly what is happening in the report. It doesn't specify that it has to be the knee region, it just indicates that it often contributes to knee tightness. According to Codify, 27025 includes debridement and is geared more towards release of the neurovascular structures in order to increase blood flow.

I also saw 27305 and agree that code describes what my physician is doing. But the lay description of 27305 states the incision and work is done in the out part of the knee/above the femoral condyle. While the incision my physician makes is in the hip area over the greater trochanteric area. That is why I was also leaning towards a 27299 and comparing it to 27305.