Cheryl Posted Thu 12th of March, 2020 14:14:08 PM
Patient with Achilles chronic tendinitis. Per OP report: Incision made on the medial aspect of the Achilles tendon, down to the paratenon. The Achilles is exposed. Retrocalcaneal bursa excised. The Achilles is excised in a pie-crusted type fashion to stimulate healing. There was some suggestion to minimal mucinous degeneration. The Achilles was then repaired. CPT 27680 or 27654? Thank you.
SuperCoder Answered Fri 13th of March, 2020 07:20:30 AM
Thanks for your question.
Code 27654 suggests that the provider opens the old incision and identifies the site of previous repair. He removes the old sutures and previously placed graft, if any from the site. He debrides the ruptured tendon and removes the scar tissue. The provider may utilize a new graft that he harvests from a separate location. He makes an incision in another area and carries it down through subcutaneous tissues. He harvests a ribbon of fascia or a piece of the plantar tendon to use for the graft, following which he closes the graft site incision with sutures. He then incorporates the graft, if used, into the Achilles tendon. He controls any bleeding and closes the soft tissue with sutures. He then closes the skin incision. He immobilizes the patient's leg in a short leg cast, splint, or brace for at least two weeks.
In code 27680, the provider makes an incision over the area of the affected tendon. He incises the tendon sheath and brings the tendon out of the tendon sheath. He removes adhesions or scar tissue from the tendon and places the tendon back in the tendon sheath so that it will slide and glide freely again. He then repairs the tendon sheath with sutures. He asks the patient to move his leg to make sure that tendon is gliding properly and working well. He closes the wound with sutures. He then applies a short leg cast for at least two weeks.
As per the limited documentation available, it appears that code 27680 is the code of choice.
Hope this helps.