Camille Posted Thu 12th of December, 2019 18:17:48 PM
Qu 1): Can I report the Achilles Tenolysis (CPT 27680) separately from the FHL to Achilles Transfer and Tenodesis (CPT 27691)? Qu 2): Is the Amniox graft reportable and if so, is that unlisted CPT 29999? DX: Left Chronic Achilles Tendinosis M76.62 Procedure: "Skin was opened. We immediately came down onto the Achilles tendon. Mostly, the peritenon was allowed to stay intact. Anteriorly, I dissected it off and dissected down around the insertion to expose this. Here, the tendon appeared to be in good quality. There were quite a bit of adhesions around the insertion at the Achilles, and I removed these with a rongeur and also to expose the calcaneus. I removed any adhesions more proximally and just debrided the tendon externally where it appeared to be fibrotic. Next, I went ahead and opened the deep posterior compartment fascia. Here, we came upon the FHL tendon. The foot was plantar flexed at both the MTP and ankle joint. We then harvested that deep in the tunnel. Brought it out and put a FiberLoop around it. It measured at a 5.5 mm tendon. We then put a pin through the calcaneus, just at the anterior portion of the Achilles, and pulled that through the bottom, then reamed down, and was able to pull the tendon through into the calcaneal hole. I then fixed it with a 5.5 mm Bio-Tenodesis screw. On the plantar aspect, we removed the suture. I then removed some of the peritenon from both and sutured the FHL into the Achilles with 3-0 PDS. Next, we got the Amniox umbilical graft. It was 6 x 3 cm. We started laterally and wrapped this at the most distal aspect of the Achilles, around both tendons, fixing it with 4-0 PDS and applying it as distally as possible. The tourniquet was then let down." THANK YOU VERY MUCH!
SuperCoder Answered Fri 13th of December, 2019 02:51:11 AM
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Camille Posted Fri 13th of December, 2019 13:46:16 PM
Possible miscommunication, not inquiring on the CPT codes. Can the Achilles Tenolysis be billed separately from the FHL to Achilles Transfer and Tenodesis? I ask because there is a CCI unbundling edit. The Tenolysis was performed on the Achilles and the FHL was transferred to the Achilles. Qu 2): Is the Amniox graft separately reportable? I have asked on particular codes in the past, but no real need for you to confirm my unlisted code selection. I'm struggling to determine if graft is separately reportable with the CPT Codes I provided to you. There is no edit for unlisted codes. Thank you, kindly!
SuperCoder Answered Mon 16th of December, 2019 03:56:13 AM
Thank you for the revised question.
For the first part of your query: Achilles Tenolysis should not be billed separately since the procedure would be considered included in the other major procedure performed on the billed date of service (FHL to Achilles Transfer and Tenodesis). Tenolysis of Achilles was a must procedure that needed to be performed before transfer of FHL to Achilles and hence should not be billed separately.
For the Second part of your query: Yes, CPT code for Amniox graft should be billed separately. As per Amniox website page, there are particular CPT codes that should be billed for Amniox specific amniotic grafts. The company website refers to use CPT codes from the code range 15271 – 15278 for the grafts.
As per the provided documentation, we should use CPT code 15275 for application of graft to feet, first 25sq cm wound surface area.
Please find below reportable CPT codes link for amniotic grafts for Amniox: