capfarr
New
CPT 27680 vs CPT 27626 for procedure Peroneus Brevis and Longus Tenosynovectomy in the Ankle (no tendon tear evident) for the below case:
POSTOPERATIVE DIAGNOSES:
1. Left chronic ankle instability.
2. Left ankle synovitis.
3. Left peroneal tenosynovitis.
4. Left symptomatic peroneus quartus.
PROCEDURES PERFORMED:
1. Left ankle arthroscopic debridement, minor.
2. Left peroneus brevis and longus tenosynovectomy.
3. Left peroneal sheath debridement.
4. Left lateral ligament reconstruction.
A curvilinear incision was then made centered about the tip of the fibula and heading towards the interspace between the fourth and fifth metatarsals. Dissecting down through skin and subcutaneous tissues, the superficial peroneal nerve and sural nerves were protected in the anterior and posterior flaps reflectively. Dissecting posteriorly the peroneal tendon sheath was identified at the tip of the fibula and it was noted to have substantial inflamed tenosynovium visible at this point. Therefore, the superior peroneal retinaculum was opened inline with the incision, taking care to leave a cuff for later repair. Vessel loops were placed around the two tendons, which had substantial inflamed tenosynovium encasing them. At this point, the patient was noted to have peroneus quartus tendon with a low muscle belly that was crowding the normal tendon. Using a pair of tenotomies, the quartus was resected and there was no longer crowding the retromalleolar groove. The tenotomies were then used to circumferentially debride the peroneal tendons to remove all of the inflamed tenosynovial material. Peroneal sheath was evaluated and still had a substantial amount of inflamed synovial tissue adherent to it. Therefore, the tenotomies were used to remove this pain generating material until only healthy sheath and retinacular material remained. The tendons were then placed back in the retromalleolar groove and with range of motion they were tracking smoothly was with no instability or catching.
I believe the best code CPT 27680 - Tenolysis, flexo0 or extensor tendon leg and/or ankle; single, each tendon.
However another resource that I have states that CPT 27626 - Arthrotomy with synovectomy, ankle; including tenosynovectomy.
I greatly appreciate any assistance!!
POSTOPERATIVE DIAGNOSES:
1. Left chronic ankle instability.
2. Left ankle synovitis.
3. Left peroneal tenosynovitis.
4. Left symptomatic peroneus quartus.
PROCEDURES PERFORMED:
1. Left ankle arthroscopic debridement, minor.
2. Left peroneus brevis and longus tenosynovectomy.
3. Left peroneal sheath debridement.
4. Left lateral ligament reconstruction.
A curvilinear incision was then made centered about the tip of the fibula and heading towards the interspace between the fourth and fifth metatarsals. Dissecting down through skin and subcutaneous tissues, the superficial peroneal nerve and sural nerves were protected in the anterior and posterior flaps reflectively. Dissecting posteriorly the peroneal tendon sheath was identified at the tip of the fibula and it was noted to have substantial inflamed tenosynovium visible at this point. Therefore, the superior peroneal retinaculum was opened inline with the incision, taking care to leave a cuff for later repair. Vessel loops were placed around the two tendons, which had substantial inflamed tenosynovium encasing them. At this point, the patient was noted to have peroneus quartus tendon with a low muscle belly that was crowding the normal tendon. Using a pair of tenotomies, the quartus was resected and there was no longer crowding the retromalleolar groove. The tenotomies were then used to circumferentially debride the peroneal tendons to remove all of the inflamed tenosynovial material. Peroneal sheath was evaluated and still had a substantial amount of inflamed synovial tissue adherent to it. Therefore, the tenotomies were used to remove this pain generating material until only healthy sheath and retinacular material remained. The tendons were then placed back in the retromalleolar groove and with range of motion they were tracking smoothly was with no instability or catching.
I believe the best code CPT 27680 - Tenolysis, flexo0 or extensor tendon leg and/or ankle; single, each tendon.
However another resource that I have states that CPT 27626 - Arthrotomy with synovectomy, ankle; including tenosynovectomy.
I greatly appreciate any assistance!!