HIP ILIOTIBIAL BAND LENGTHENING (open)

Meljmichon

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I am having a hard time figuring out which code i should be using for the : HIP OPEN IT BAND LENGTHENING. The pt also had an OPEN Trochanteric Bursectomy 27062 & OPEN Abductor Tendon Repair (unlisted compared to 27405).
I am debating between the 27025 or the 27305?

Here is the OP Note:
LEFT HIP TROCHANTERIC BURSECTOMY THE IT BAND LENGTHENING AND ABDUCTOR TENDON REPAIR: At this point, after having done a timeout then prepped and draped the patient having all the antibiotics being infused, a 10 cm incision was performed centered over the trochanteric bursa. Copious irrigation was performed. The dissection was then performed so that it went deep down through the subcutaneous fatty tissue down to the IT band. The IT band was incised in line with the incision. After the IT band was incised a huge amount of synovial fluid was identified. Copious irrigation was performed and there was extensive amounts of thick, hard scarred in bursitis that were noted in the trochanteric bursal area. At this point, the bursa was excised completely from the trochanteric space. Copious irrigation was performed. Once the bursa which was thickened and edematous was excised completely, we were then able to identify the abductor tendon. The abductor tendon had a partial high-grade tear all the way through. There was an area of abductor tendon tearing that was a full thickness tear. The tendon was debrided until a stable edge. The footprint of the tendon was debrided using a rongeur and curette. We could then get to good healthy bleeding bone. Two Smith and Nephew Healicoil 5.5 mm PEEK anchors were then placed at the footprint of the tendon, passing the 3 suture pairs in a horizontal mattress fashion through the tendon. The tendon was then reattached medially back to the footprint. Two Arthrex 4.75 mm BioComposite SwiveLock anchors were then placed laterally and 6 sutures were placed over the tendon in a lattice form fashion compressing creating a double row repair. Excellent tendon repair was noted back to the greater tuberosity. Copious irrigation was performed. The hip was rotated internally externally. The abductor tendon had been fully repaired down and there was no further gapping of the tendon. The footprint of the tendon was completely covered. Having resected the entire bursa irrigation was performed. The tendon repair had now been performed. At this point, we repaired the IT band in a longitudinal fashion. I created a small slit posteriorly at the very distal part of the IT band in the posterior leaflet and then anteriorly at the very proximal part of the IT band anterior leaflet. This in essence created a lengthening and then we created small perforations through the IT band throughout its course to create a full lengthening of the IT band. Then, using #1 Vicryl, the IT band was then repaired side-to-side and in fact that we had now created a Z lengthening. Copious irrigation was performed. The subcutaneous tissue was closed first with 2-0 Vicryl followed by 3-0 Monocryl in a subcuticular fashion. Mastisol, Steri-Strips, Xeroform, dry sterile dressings were applied.

Thank you
 

AlanPechacek

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This is complex to code, as you are aware. As for the Trochanteric Bursectomy, 27062 is correct. For the Abductor Tendon Repair, there is no real code for this. Code 27405 refers to a the primary repair of a torn collateral ligament at the knee, which is not really a tendon repair. The best code for this would be 27299: Unlisted procedure, hip. The closest tendon procedure at the hip that would be comparable to Abductor Tendon Repair would be 27110: Transfer of the Iliopsoas to the Greater Trochanter.
The IT Band "Lengthening" as he did it is a modified Ober-Yount Procedure, an old procedure done for Polio residua resulting in an Abduction Contracture of the hip and thigh due to a tight IT Band. More recently, the Ober part of the procedure, which is a transverse tenotomy of the IT Band at the level of the Greater Trochanter (hip), is being done for Chronic Trochanteric Bursitis. The Yount portion by tradition was a transverse tenotomy of the IT Band in the lateral lower thigh, above the knee. He "performed" this part by multiple "Stab Wounds" of the IT Band down the lateral thigh. In the "Femur (Thigh Region) and Knee Joint," in CPT, 27305: Fasciotomy, Iliotibial (tenotomy), open, states that for Ober-Yount fasciotomy, use 27025, so "technically" this is what he did. The confusing part of this is that 27006: Tenotomy, open, Abductors &/or Extensors, (separate procedure) is also there. By definition a "Fasciotomy" is an incision/opening (only) of the fascia, but not defined as to direction (transverse or longitudinal, etc.), whereas "Tenotomy" is the transverse incision/cutting of a tendon, allowing it to relax/lengthen. So, in another respect, he did a Z lengthening tenotomy of the IT Band at the hip. From the CPT standpoint he did a Modified Ober-Yount procedure, so I would go with that with Modifier 22 for Increased Procedural Services. As for all the procedures, I would check the RVU's, then list/rank the other procedures in decreasing value, and add Modifier 51 for Multiple Procedures to the second and third on the list. You may want the surgeon to prioritize them for you. And send the Operative Report for supportive documentation.
I hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com
 

Meljmichon

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Arthroscopic it band lengthening

Thank you for your response. I do have one more question regarding what i should be comparing the Unlisted Arthroscopic 29999 code to when the surgeon performs the IT Band Lengthening Arthroscopically. This is his preferred technique and we were comparing this one to the 27305 but i am not sure if that makes sense as it seems as if he is just creating a lengthening by cutting a T shape in the IT Band. I have included the portion of the OP Note below describing the IT band lengthening.


-----The trochanter was rotated internally and externally. There was
bruising and ecchymosis of the IT band over where the greater trochanteric
region was probably rubbing on it in the posterior aspect. Once the bursa had
been completely excised, we then decided to do an IT band lengthening. Using an
arthroscopic radiofrequency ablation device, a small incision vertically in the
IT band was performed so that the posterior half of the IT band was lengthened.
A T-shaped incision was created and the flaps were resected, creating a small
opening right over the greater trochanteric region. Once again, copious
irrigation was performed. Having performed the trochanteric bursectomy and IT
band lengthening, all the arthroscopic equipment was removed. ----

Any suggestions?
 
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