Need some guidance, would you just code 27658?

Thanks in advance,
Melissa Bedford,CCS,CPC




PREOPERATIVE DIAGNOSIS:
1) Peroneal Longus Tendon Rupture Right
2) Peroneal Brevis Tendon Tear Right

POSTOPERATIVE DIAGNOSIS:
Same

PROCEDURE:
1) Primary Repair of Peroneal Brevis - Right
2) Peroneal Anastomosis Peroneal Longus/Brevis Tendon Right

PATHOLOGY:
none

ESTIMATED BLOOD LOSS: less than 5mL

MATERIALS:
2-0 Tycron
2-0 Vicryl
3-0 Nylon

COMPLICATIONS: none

ANESTHESIA: regional
Pre-op Pain Block

HEMOSTASIS:
Pneumatic Ankle Tourniquet at 250 mmHg x 72 min

INJECTABLES:
15 mL 0.5 % Marcaine


SUMMARY OF PROCEDURE:
Patient was brought into the operating room and placed on the table in the supine position. A time-out was performed with myself in the room verifying correct patient, procedure, extremity, materials present and administration of ordered antibiotics.


The right extremity was prepped and draped using standard aseptic technique. A well padded tourniquet was applied to the extremity.


Attention was directed to the lateral aspect of the right ankle. A curvilinear incision was placed posterior to the lateral malleolus overlying the peroneal tendon sheath. The incision was deepened with blunt as well as sharp dissection. Superficial vessels were cauterized. Care was taken to avoid the sural nerve. Peroneal tendon sheath was identified.


The peroneal retinaculum was found to be intact intact. A linear incision was made into the peroneal sheath producing significant amount of fluid. Irrigation was employed. The peroneal tendons were evaluated with partial thickness tear, 7 cm within the peroneal brevis tendon. The peroneal longus tendon had a complete rupture with retraction of the proximal section to the level of the distal fibula. The distal segment was absent, with retraction to the plantar foot. There was a significant amount of tenosynovitis within the area where the longus tendon normally is. This was debrided and flushed. Primary repair of peroneal brevis tendon repairs was performed utilizing 2-0 Tycron. The proximal stump, with the minimal amount of tissue remaining was debrided and a anastomosis to the proximal peroneal brevis tendon was performed with 2-0 Tycron. The area was flushed. The peroneal tendon sheath was reapproximated with 2-0 Vicryl. Peroneal retinaculum was also secured with 2-0 Vicryl. Irrigation was employed. Subcutaneous tissues were also approximated with 3-0 Vicryl. Skin was approximated with 3-0 nylon. A well-padded nonadherent bandage was applied. Tourniquet was released with immediate capillary refill to all toes. Posterior Splint Applied. Patient was awakened and transferred to recovery room with all vital signs stable intact to the foot.