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Ankle surgery

Jeannie Posted Tue 07th of March, 2017 12:43:44 PM
I need help...I am new to coding foot & ankle surgeries & I need help. The dx codes listed are 1)left medial talar osteochondral lesion, 2) synovitis, 3) unremitting pain. Surgical procedures: 1)Lt ankle arthroscopy w/ext synovectomy & debridement, 2)Anterior tibial spur excision arthroscopically. 3) Medial malleolar osteotomy w/ORIF of the medial malleoulus. 4)Open debridement of the talar osteochondral lesion w/the De Novo chondrocyte implantation. All help in coding this is greatly appreciated. Thank you!
SuperCoder Answered Wed 08th of March, 2017 08:16:38 AM

The codes are given on the considering that the procedure are performed on the ankle only. Your desired Dx and Sx codes are as follows:

ICD-10 Codes:

1) Left medial talar osteochondral lesion- M93.272

2) Synovitis ankle- Right- M65.871, Left- M65.872

3) Unremitting pain, ankle- Right- M25.571, Left- M25.572

CPT Codes:

1)Lt ankle arthroscopy w/ext synovectomy & debridement:

For ankle arthroscopic debridement and synovectomy use CPT 29897-LT, 29895-59, LT.

2) Anterior tibial spur excision arthroscopically:

Use CPT 29891 for bony defects of tibia, the code is arthroscopic procedure for - ankle, surgical, excision of osteochondral defect of talus and/or tibia.

3) Medial malleolar osteotomy w/ORIF of the medial malleolus:

For ORIF of the medial malleolus use CPT 27766, osteotomy for the same site will be included if performed during the ORIF.

4) Open debridement of the talar osteochondral lesion w/the De Novo chondrocyte implantation.

Use CPT 27899- Unlisted procedure of ankle for the procedure.

Jeannie Posted Tue 14th of March, 2017 08:03:54 AM
What code would I use as the comparison code for the unlisted 27899? Also can 29898 be used for the arthroscopic debridement & synovectomy? I have seen this code used for these procedures on some of the previous coding. Thanks
SuperCoder Answered Wed 15th of March, 2017 06:03:41 AM

For comparison code of CPT 27899, debridement of the talar osteochondral lesion can be CPT 29891 and 29892- osteochondral defect of talus is being rectified in both the codes by different methods and with different reasons. As these codes are of arthscopic pattern and your procedure is being performed with open approach, that is why unlisted code is suggested.

On the other hand, CPT 29898 is for the extensive debridement of ankle (tibiotalar and fibulotalar joints). I suggested the code for limited debridement i.e. CPT 29897, but if your documentation support extensive debridement then you can choose CPT 29898.

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