# Tendon lenghtening with osteotomy



## KORBISCHM (Jul 24, 2018)

I am in between codes 27685 vs. 28200. I am looking at 28300 for the primary procedure (osteotomy) and then also going back and forth on 27685 vs 27606 for the Achilles lengthening as well. My biggest issue is the approach seems to be the foot for the peroneus brevis tendon not the leg/ ankle which is where I am struggling. Any help would be wonderful!

"At this time a lateral approach was made to the left foot over the calcaneus.  Identified the calcaneocuboid joint.  As we came down through the subcutaneous tissue to approach the lateral aspect of the calcaneus we encounter the peroneus brevis tendon.  It was very tight across this area and it was restricting her ability to correct the abduction of the foot.  At this time we opted with to go ahead with a Z lengthening of the peroneus brevis tendon because it was clearly contracted.  
*
Once we had at the lateral calcaneus exposed we took two separate 2 mm wires and through the cuboid into the front portion of the calcaneus to support the calcaneocuboid joint to prevent subluxation of the calcaneocuboid joint.  Then made a bone cut across the calcaneal neck.  We verified this with fluoroscopy.   We were able to get about a 12 mm opening and placed a 12 mm patella allograft that was fashioned.  We had good fixation.  Pins were advanced  slightly for good purchase in the front of the calcaneus to hold the calcaneocuboid joint.
*
 At this time we completed the Z lengthening and repaired the peroneus brevis tendon with two 0 Vicryl sutures.  Wound was irrigated.
*3 O Vicryl to close the subcutaneous tissue and four Monocryl interrupted on skin.
*
We then a rotated the leg and through  three incisions on the back of the Achilles on the left side did an Achilles lengthening to bring the foot to neutral. "


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## Orthocoderpgu (Jul 25, 2018)

*You need to find out if the doc is working in the ankle or foot*

There is no way to tell from the documentation if the doc is working at the ankle level or the foot. Answering this question will give your answer. 

Be careful with the Z-lengthening procedures, they are usually designated as "Separate Procedures" so they may not be reportable.


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## KORBISCHM (Jul 25, 2018)

I questioned him further on this as well after giving him the procedure lay description of 27685 and he replied with the following:

"As we lengthen the lateral column of the foot thru a calcaneal osteotomy,  the peroneus braves tendon that is all ready contracted prevents the lengthening and leads to recurrence so we will lengthen the tendon if it is tight. 

When I look at your description you are describing complete midfoot and hind foot releases such as with an extensive release - these would be the 28200 codes for foot and toes. 

Where did this description come from since the code is for a tendon lengthening of the ankle or leg and has nothing to do with the foot?"

I am assuming then if it is at the ankle level this should be 27685 and if it is the foot 28200? He is stating that the lengthening procedures are due to separate contractures outside of the normal procedure he was performing for the osteotomy. This procedure is really throwing me for a loop- any help would be greatly appreciated.


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## Orthocoderpgu (Jul 25, 2018)

*your provider knows the difference between the ankle level and foot level*

It's only throwing you for a loop since your provider is not answering your question. The procedure was either performed at the ankle level or foot level, and the op note does not make it clear which it is.

After working with my foot and ankle surgeon he clearly documents if he is working at the ankle level or foot level.

You have another problem. There is a 99% chance that the insurance will deny the Z-lengthening procedures, even if you bill them with a -59 modifier and a different diagnosis. So your will need to do an appeal with your op note. After review the insurance company will deny the procedures because it's unknown where the procedures are being performed and are not documented.

I've gone through this a dozen times, just an FYI.

Just ask him if the procedure was done at the ankle level or foot level.


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## KORBISCHM (Jul 25, 2018)

I will be following up with him on this. Am I correct then with the Achilles lengthening that this is a 27685 instead of a 27606?


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## Orthocoderpgu (Aug 1, 2018)

*yes*

Use 27685 for tendon lengthening IF it was performed at the leg/ankle level.


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