Wiki repair of the peroneus longus and peroneus brevis tendon cpt help

[Miko24]

Procedure #4: Peroneal brevis tendon repair CPT code: 27659 or 27659 ??
A significant mount of rubbing was appreciated to the peroneal brevis tendon where there is significant tearing mid substance.
With use of 3-0 FiberWire a modified Kraków suture technique was then performed the length of the peroneal brevis tendon. A
significant mount of scar tissue from the previous fracture was removed with use of a #15 blade and the low-lying muscle belly
was then removed as well, as well as rubbing on the plate was then removed with use of a #15 blade prior to being repaired. The
area was then flushed with copious amounts of sterile normal saline.

Procedure #5: Repair peroneal longus tendon CPT code 27675 or 27659 ??
Due to the significant rubbing of the peroneal longus tendon on the plate as well as the significant previous injury there is a
significant amount of longitudinal tearing appreciated to the peroneal longus tendon. With use of a #15 blade this was then
debrided and with use of 3-0 FiberWire in a modified Kraków suture technique was then performed to tubularized and repair the
peroneal longus tendon as well.

 

[amyjph]

The first question has a typo, do you mean 27657 or 27659 for both? Also the 28200 area has to be considered depending on location. There is a CPT Assistant Feb 2016 Volume 26 Issue 2 which instructs 28200 is used for peroneals.
Please read the descriptions of the two different CPT codes. Dislocating peroneals is not the same thing as torn.
What else was performed during this case if these are procedures 4 & 5? It may make a coding difference. Why was this done? It seems the patient had a prior surgery/fracture (distal fib?) and there is hardware which caused or contributed to the tearing. It was a hardware removal too?

 

[Miko24]

Thank you for answering, I am new to podiatry.
Yes i was not sure if the code was 27657 or 27659> I choose one of these 2 because op note said tear???
The patient also had:
Gastrocnemius Recession
Hardware removal lateral calcaneus - extensive
Subtalar joint arthrodesis
Peroneal Brevis Tendon Repair
Peroneal Longus Tendon Repair
Neuroplasty sural nerve
Secondary lateral ankle ligament repair
osteotomy of the calcaneus
Stress views of ankle

 

[amyjph]

You're welcome. Oh dear, that's a big one for a "newer" person to podiatry There is a lot going on here. With new folks what I suggest is taking the op note and outlining it. Write the codes you think it is on the header next to the procedures and diagnoses. Then, go to the body of the report and highlight or mark where each of the codes in the header was done. You have to make sure it is all described. Once you do that, you would have to plug them into an edit checker to see what bundles, etc. Read the description of each CPT to see if that matches what was actually done.

What resources do you have access to? Encoder, AAOS Global Data Guide, anatomy books, etc? Foot and ankle surgery requires resources, understanding the anatomy and understanding the bundling edits.
While 27657 says "repair" it can be a little misleading, it is used for when the peroneals are dislocating out of the fibular groove they normally sit in on the lateral side of the ankle. I would suggest reading up on the two codes and looking at lay descriptions as well as anatomy diagrams to see. The description you have above is not this, it's a fraying or tearing of the tendons due to rubbing on the hardware and the prior surgery in the area. From the descriptions they are not necessarily dislocated. They would call out dislocating or snapping and usually they do the fibular osteotomy to re-seat them. It's not as common to see the 27657 as the 28200/27659(8).