# Posterior tibial tendon dysfunction w/pes planus of Right Foot



## joanne71178 (Oct 3, 2013)

I am stumped by this OP note.  The codes I am considering are: 27691, 28238 and possibly and unlisted for for the Spring Ligament repair.  Any thoughts would be very helpful. 
Thanks in advance


PROCEDURE: 
1.Repair of spring ligment
2. Tenodesis of the posteror tibial tendon
3. Transfer of the flexor digitorum communis through the navicular for augmentation and transfer of the posterior tibial tendon
4. Synovectomy of the posterior tibial tendon.

Description: 

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Carefully placed postero-medial incision carried across the posterior ankle and foot.  The tendon sheath for the posterior tibial tendon was then identified distally and carried proximally.  An incision was then made in the sheath and the tendon identified.  It was attenuated at every level, with multiple areas of thickening and tendon attenuation.  A synovectomy of the posterior ankle ws then carried out along the poterior medial malleolus.  The flexor digitorum communis was identified both proximally and distally, and isolated distal to the insertion of the flexor posterior tibial tendon.  It was then isolated with a retractor and incised.  It was then brought through the posterior tibial tendon sheath more proximally.  The foot was then placed in slight eversion and plantar flexion, and the tendon then placed placed with the whip stich throughout its course of the distal end.  A 4.5mm drill hole was then created in the navicular from anterior to posterior, with careful retraction and protection of the underlying neurovascular structures.  The tendon was then brought from inferior to superior through the hole and tenodesed with a bio-tenodesis screw.  It was then sutured back onto the posterior tibial tendon.  

The foot could be taken in plantigrade position with some resistanc of the tendon, but appreared to be in excellent position.  
The spring ligament was then repaired by placing the suture arm through the tenodesed tissue intot he spring ligament and holding it in place, along with another suture anchor placed into the spring ligament attachment.  This was then sutured with fiber tape across the navicular.  The wound was copiously irrigated, tendon sheath then cloded after tourniquet was released........


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## joanne71178 (Oct 10, 2013)

anyone have any thoughts?


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## CJoy0724 (Jan 20, 2014)

*Answers?*

Just wondered if you ever came up with a code for the spring ligament repair? We have a physician scheduling one and I am stumped. Our authorizations person is wondered what code to request auth for. Unlisted?


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## amyjph (Feb 26, 2014)

The spring ligament or calcaneonavicular ligament is a ligament of the ankle.  Therefore, if repair/reconstruction is done I would look at 27695-27698

Calcaneonavicular Ligament (Spring Ligament) 
?Function 
◦static stabilizer of the medial longitudinal arch and head of the talus
?Anatomy 
◦attaches from the sustentaculum tali to the inferior aspect of the navicular

Here is a link to more info (found online):

http://wjweiser.com/securesite/iss/...Abstracts/SPORTS IMAGING DAY 3/Bencardino.pdf

Amy Phillips, CPC, COSC, CSFAC


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