# Excision of bony ossicles



## Rufus186 (May 11, 2017)

Can CPT 27360 partial excision(craterization,saucerization, or diaphysectomy) of bone, femur, proximal tibia and/or fibula(eg, osteomyelitis or bone abscess) be used for excision of bony ossicles on the tibial tubercle of an adult pt with status post Osgood Schlatters Disease?  My concern is the examples does this mean the pt must have some type of infection or necrosis?  Any suggestions are greatly appreciated! Thanks in advance!


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## AlanPechacek (May 12, 2017)

Osgood-Schlatter"s Disease (M92.5 _) is a disorder of adolescence involving the portion of the proximal tibial epiphysis that extends over the front of the proximal tibia that forms the tibial tubercle (the knob on the front of the tibia just below the knee).  It is an Osteochondrosis/Osteochondritis disorder with inflammation of that portion of the epiphysis, and sometimes is called Epiphysitis.  The inflammation causes local pain and tenderness with swelling, and the symptoms are usually aggravated by physical activities (sports), and pain with kneeling and crawling on the knee.  The disease process stops when the growing is complete, but it is fairly common for the patients to have an enlarged residue tibial tubercle when all is said and done.  This may also still be tender to kneel and crawl on.  Sometimes at the end of the disease these patients may have an ossicle or bone fragment(s) left at the tibial tubercle that did not "heal" back to the rest of the tubercle.  They can be superficially placed on/at the front of the tubercle, or sometimes located/hidden deep to and behind the lower/distal end of the Patellar Tendon.  Usually there is one fragment, but occasionally more.  If sufficiently large, tender, etc. and symptomatic, their removal may be necessary to try to relieve the local pain and functional/activity related symptoms.  Depending on the location of the ossicle(s), the complexity to the procedure can be fairly simple to more extensive/complicated.  For what it is worth, there is no really good code for this.  I am not sure 27360 that you mention is the best as this implies that the disease process being treated is infectious, which Osgood-Schlatters is not, and it also indicates a more extensive removal of bone than is done for removal of these fragments of bone.  Unfortunately, probably the best is an Unlisted Procedure of the Knee, 27559.  As for pairing it with another code of relatively equal value, that is also tricky.  The closest I can find are 27327:  Excision of tumor ("ossicle"), soft tissue of the knee, superficial, < 3 cm. (which most of them are), or possibly 27340:  Excision of Prepatellar Bursa.

I hope this gives you some help.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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