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Sara Posted Mon 19th of September, 2011 17:54:46 PM

I coded the below surgery as 27635 and DX 726.91. Insurance is denying as DX does not match procedure. Under CPT 27640 and 27641 is states for excision of exostosis, use 27635.
First I would like to make sure Im coding this correctly and if I am, does anyone know of any documentation that can help to get this paid/ Any help would be appriciated.

DIAGNOSIS: Osteophytes/exostosis on the lateral ankle gutter region.
OPERATION PERFORMED: Excision of exostosis/osteophytes lateral ankle gutter region.

There were osteophytes on the anterior part of the fibula as well as the anterolateral aspect of the talus and these were debrided at this time using rongeurs and a rasp. We elevated a sleeve of tissue off the anterior part of the fibula so we could do a pants-over-vest reconstruction of the lateral ligaments. Once we had
elevated this tissue with a sharp knife, we used a combination of a rongeur and a curette to create a good bleeding trough for our repair. Once we did this, we irrigated with copious Bacitracin laden irrigation. We then proceeded to perform a pants-over-vest suturing and imbrication of the lateral ligaments using interrupted 2-0 Ethibond sutures. After we placed these sutures in
position, we held the ankle in neutral dorsiflexion and plantar flexion with slight eversion and tightened the ligaments down. When we finished this, we took the ankle through an initial stability examination. It had good tension and good stability. We brought up the inferior extensor retinaculum, we reinforced the repair with interrupted 2-0 Vicryl sutures. We sutured the inferior retinaculum to the flap left over from the pants-over-vest reconstruction.

SuperCoder Answered Tue 20th of September, 2011 00:27:18 AM

The procedure starts with debridement this time using rongeurs and a rasp. Please check if this is a secondary procedure following a previous surgical repair.
If it is a Secondary repair, then for pants-over-vest reconstruction of the lateral ligaments the code would be 27698, i.e., a Brostrom-Gould CPT.
If it is a primary procedure, billing 27635 as a primary procedure would need at least 731.3 as primary Dx here.

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