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Help with surgery - Achilles tendon

  1. Default Help with surgery - Achilles tendon
    Medical Coding Books
    My Dr wants to charge 27654 x2. I dont know if that going to work and was looking for another opinion and to see if there was any other code that might work. Thanks so much in advance!

    Chronic left Achilles tendon rupture.

    1. Repair of chronic Achilles tendon rupture.
    2. Turned-down flap augmentation of chronic left Achilles tendon
    rupture repair.

    We identified the sural nerve and this
    was retracted laterally. We also identified the area of the
    chronic tearing. Interposed in this tear, which was located
    about 6 cm above the insertion into the calcaneus, there was
    abundant scar tissue in around the area. We performed
    debridement of the scar tissue. We identified the viable ends of
    the tendon. We debrided back until we got good viable bleeding
    by blunt and sharp dissection. Once we had established the
    viable ends of the Achilles tendon, we were initially left with
    about a 6 cm difference. We took a 2-0 Ethibond suture and we
    performed a Bunnell type of weave through the more proximal
    segment, and we then took the weave and the tendons and we pulled
    gentle traction on this, allowed the Achilles tendon to come back
    out to length. We digitally and manually were able to dissect
    out adhesions to the paratenon higher up within this area. After
    about 5 minutes of doing this, the gap was reduced down to about
    2 cm. At that point, we were able to plantarflex the foot with
    only mild levels and we were able to re-oppose the major segments
    and we tied off the #2 Ethibond sutures, 1 being in the proximal
    segment and then a second that we had placed in the distal
    segment. Prior to doing this, we took a posterior midline
    fascial band of about 1.5 to 2 cm and we left it hinged just
    above the tear site and this fascial band was in the midline of
    the proximal segment of the Achilles tendon. We took this band,
    we elevated off the underlying muscle, and we closed this
    interval with interrupted Ethibonds and absorbable sutures. This
    free band that we had created was approximately about 10 cm long.
    We then swiveled this band of tissue for transfer of this
    turned-down flap. We sutured it down in place and then rotated
    so that the glistening part of this tendon was exposed as part of
    our repair, and then we essentially used this tendon as almost a
    candy cane type of wrap around the repair site and then sutured
    it proximally into the major tendon site and then distally into
    the distal site, and then we sutured it down to overlying the
    repair site to serve as augmentation. When we had completed
    this, we stressed the Achilles tendon, had good stability to
    stress examination. We augmented the repair with interrupted
    absorbable and nonabsorbable sutures. After we completed again
    we had a good stability of our repair with good tension on it.

  2. #2
    Why 2 units?

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