# coding repair of achilles w/ fhl as graft?



## npatandin (Mar 16, 2009)

PREOPERATIVE DIAGNOSIS:  Left Achilles tendinosus and Haglund's disease.

POSTOPERATIVE DIAGNOSIS:  Same.

NATURE OF OPERATION:  Left Achilles tendon debridement and repair with graft, flexor hallucis longus tendon transfer and partial ostectomy calcaneus.

OPERATIVE INDICATIONS:  The patient is a 46-year-old gentleman who has had over two years of pain in his left posterior heel, some interstitial signal on MRI was noted.  The patient failed all conservative treatment and has agreed for surgery.

OPERATIVE PROCEDURE:  The patient was brought to the operating room, placed in the prone position.  Preoperative antibiotics were given.  A popliteal nerve block was performed by anesthesiologist.  The patient was then set up and a spinal anesthetic was given.  The patient was then placed prone.  The appropriate padding of bony prominences was performed.  A left thigh tourniquet was applied.  The left lower extremity was prepped and draped in the usual sterile fashion.  Left lower extremity was exsanguinated with Esmarch bandage and the tourniquet was inflated.  

A longitudinal incision was made to the posterior aspect of the heel just medial to midline.  Subcutaneous tissue was divided.  Paratenon was incised and elevated off the tendon.  The Achilles tendon and its insertion were exposed.  Some chronic fibrotic changes seen near the incision.  A longitudinal incision was made in the midline of the tendon.  Fibrotic tissue within the core of the tendon was debrided.  The Haglund's deformity was identified and was resected with an osteotome.  The insertional spur was also resected with an osteotome.  Once this was done, the area was checked fluoroscopically and all the excess bone was appropriately debrided.  The edges were then smoothed out with a rasp and the area was thoroughly irrigated.  Further dissection exposed the FHL tendon.  The fascial overlying muscle was slightly released in order to further dissect out the tendon that was down into the posterior medial tunnel.  Tibial nerve was not injured.  The tendon was isolated and then cut.  At that point, two G2 suture anchors were placed near where the Achilles tendon insertion is in the calcaneus.  The sutures of the more posterior anchor were placed into the FHL tendon and tied down so the tendon was then transferred to the calcaneus at appropriate tensioning.  The more anterior anchor sutures were then used to do a running repair of the Achilles tendon with FHL incorporated into the tendon as a graft.  This was done and the sutures were then tied down.  Once this was done, the Achilles tendon was appropriately attached to the calcaneus and incorporated with the FHL tendon.  

At that point, the wound was thoroughly cleaned and irrigated.  The paratenon was run with a running 4-0 Vicryl suture, subcutaneous tissue with a 4-0 Vicryl suture and the skin was closed with interrupted 4-0 nylon suture.  Xeroform gauze dressing was applied with an AO splint incorporated into the bandage.  The patient awoke from anesthesia without complication and transferred to the recovery room in stable condition.

Nalini


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## jweidman (Apr 20, 2009)

I work for anesthesiologists and need CPT codes to get correct anesthesia code. I posted a similar question in the ortho forum and 28119 cpt code was suggested. Today, I had a similar op report and I am still not sure if I am using the correct code when they refer to tendon debridement. If you have any additional coding for both CPT and ICD9 codes for your op report I would be interested.


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