# Exostosectomy of calcaneus



## KNP40806

I need help. I do very little orthopaedics so I'm a little lost on this one. Any direction would be helpful. 

DATE OF PROCEDURE: 10/28/09

PREOPERATIVE DIAGNOSIS:	Haglund's exostosis of right heel with retrocalcaneal bursitis.

POSTOPERATIVE DIAGNOSIS:	Haglund's exostosis of right heel with retrocalcaneal bursitis.

PROCEDURE:	Exostosectomy of calcaneus, right foot.

SURGEON:		
ANESTHESIA:	General.

ESTIMATED BLOOD LOSS:	Minimal.

TOURNIQUET TIME:	36 minutes at 250 mmHg.

COMPLICATIONS:	None.

DESCRIPTION OF PROCEDURE:  	The patient was brought to the operating room and placed in supine position.  General anesthesia was administered.  A gram of Ancef was given.  She was placed prone on the operating table and the tourniquet was placed on the right proximal calf.  The right leg was prepped and draped in sterile fashion.  The tourniquet was inflated to 250 mmHg and then a posterolateral incision was made over the right heel just in front of the edge of the Achilles at the attachment to the calcaneus.  The soft tissue was dissected down. 


Retractors were placed and the exostosis was exposed with partial elevation of the Achilles.  Exostectomy was performed using osteotomes and then due to the release of the Achilles we placed 5.5 Arthrex bioabsorbable suture anchor in to the calcaneus with FiberWire suture.  This was passed through to re secure the Achilles to the calcaneus.  After this, the soft tissue were closed using 2-0 Monocryl for subcutaneous tissues and 4-0 Prolene stitch for the skin.  The incision area was injected with 0.25% plain Marcaine.  Dressing was placed followed by posterior and stirrup splint.  The patient tolerated the procedure well.  There were no immediate complications.  She was awakened and taken to the recovery room in stable condition.


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## justkath

Hi the code I would use is 28120 - hope that helps!


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## BCrandall

I'd use 28119 and I'm leaning to 28230 for the tendon release/repair, but then again that's probably inclusive by the insurance. Dx is 726.73.

Good Luck!
-Bruce


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## ASC CODER

coding coach med assests states


Pump bump 
Whether called “pump bump” (for association of shoe pumps causing irritation on the back of the heel), HAGLUND, bone spur or exostosis of the calcaneous, is normally the same CPT code 28118. Excision of a bone spur through the Achilles tendon can also be reported using 28118 because the attaching or reattaching of the Achilles tendon to get to this spur would be considered inherent in the removal of the spur. CPT code 28118 represents, “Ostectomy, calcaneus.” Now CPT code 28119 represents, “Ostectomy, calcaneus; for spur, with or without plantar fascial release,” which would be reported when there is a spur on the bottom of the foot and a plantar fascial release may


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