# Reconstruction of Achilles tendon



## kellit21 (Sep 23, 2013)

Can anyone help me with the cpt codes for this surgery?

Reconstruction of the right tendo-achilles with V-Y lengthening and direct end-to-end reanastomosis


----------



## kellit21 (Sep 25, 2013)

Does anyone have any help?


----------



## dclark7 (Sep 25, 2013)

There are three CPT codes for reapir of achilles tendon 27650, 27652 and 27654.  There's not enough information here to help you.  If you could post the redacted op note, you may get more responses.


----------



## kellit21 (Sep 25, 2013)

*op-note*

Postop Diagnosis: Chronic re-rupture of the right tendo-achilles, status post deep soft tissue infection, resolved.

Procedure: Reconstruction of the right tendo-achilles with V-Y lengthening and direct end-to-end reanastomosis.

Description:
the previous incision which is in the medial border of the terminal achilles tendon was utilized and extended proximally to the upper end ofthe leg, care taken to avoid the posterior midline in the vicinity of the sural nerve. Working from fresh virginal tissue, we were able to open the sheath of the musculotendinous unit proximally and then worked distally through the scar until the residual tendon was completely uncovered. We also extended proximally far enough to see the musculotendinous junction.

Findings at this point were surprising amount of scarred in tissue resembling tubular tendon. This may be in part had been from the BIOTAPE construct that we had used for his initial surgery. However, under direct visualization, Thompson test showed that the tendon was over long and the muscle could not fire sufficiently to create plantar flexion.

The V-Y lengthening portion of the procedure was performed proximally with about a 5cm limb length of the V. The watershed area of the tendon was palpated and an irregular section of about 2 1/2 to 3 cm was removed and discarded. A #2 FiberWire suture was then attached to the proximal tendon stump and 10 pounds of traction weight was applied to the V-Y lengtheningarea, which gained us about a centimeter and a half to 2 cm of additional length. Meanwhile, the terminal stump was sutured with the same #2 FiberWire. This was in plantar flex briging the tendon ends onto direct contact. The sutures were then tied. Supplemental running 3-0 Vicryl was used to smooth and tubularize the repair site. Additionally, we had a strip of plantaris tendon that was available from proximal end and we sutured that crossing the repair site 2 separate directions. The V-Y was then repaired with interrupted 2-0 Vicryl. Photographs were takenduring the course of the procedure for documentation.


----------



## dclark7 (Sep 25, 2013)

Look at 27654


----------



## kellit21 (Sep 25, 2013)

Would this code include the V-Y lengthening? Or would I use another code like 27685?


----------



## dclark7 (Sep 26, 2013)

This would include the V-Y lengthening.  27685 is designated as a "separate procedure" so you would only use it if the only procedure done was the lengthening.


----------



## kellit21 (Sep 26, 2013)

Thank you so much!!


----------

