# Excision Pes Bursa



## martnel (May 11, 2009)

What code would y'all use for excision of this bursa in the knee? I do not have opnotes yet, this needs pre-op coding and I cannot find anything that make sense to me. Any help would be appreciated! Thanks!


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## nikkisgranny (May 11, 2009)

Look at 27435 (726.61). I don't know if this will help or not.


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## mbort (May 11, 2009)

look at 27340

Mary, CPC, COSC


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## martnel (May 11, 2009)

27435 does not sound right to me..or do I miss the "excision" part in that code?  

27340 is a bursa in a different location:

From jointhealing.com:

"Usually bursitis produces a very specifically located swelling on your knee.

Pes Bursitis is swelling located on the inside (medial) part of your knee along the upper part of your tibia. The pain of bursitis is usually sharp and worse with either touching the area or even when you sleep and the two knees touch each other. This typically happens in older patients. 
Patellar bursitis, or "pre-patellar bursitis", is located over the front of the patellar ligament and kneecap (patella). The pain is located right in the front of your knee, and it can even be painful to have the bedsheets touch your skin in this area."


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## mbort (May 11, 2009)

picky picky picky...you just said bursa..you didnt tell us where (other than the knee) !!  LOL

Do you have the op note to post?


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## martnel (May 12, 2009)

I am sorry Mary! I should have been more clear!

Here is the opnote, it just came in and I myself have not even disected it yet:

Open right pes bursectomy with harvesting of gracilis and semitendinosus hamstrings.

... A 3 cm incision was made over the pes bursa beginning approximately 3 cm inferior to the medial joint line and 2 cm medial to the tibial tubercle.  Subcutaneous dissection was carried out, exposing the pes insertion site.  It was then split longitudinally down to bone and then horizontally along the superior margin of the sartorius through the sartorial fascia.  It was then folded back, revealing the gracilis and semitendinosus tendons.  Both were robust in size.  They were then each carefully harvested by attaching a small Kocher and then bluntly dissecting superiorly, inferiorly, medially, and laterally along the tendons to protect the saphenous nerve.  There was no significant tethering of either including the semitendinosus.  The open-ended pigtail passer was then used to harvest both with the first pass on each with no immediate complications.  The bursa was then further debrided sharply using Metzenbaum scissors....


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## martnel (May 12, 2009)

I'm lost on this one...I was going to use 27391 for the tendon release which he scheduled, but now he changed that to "harvest". On the bursa excision I cannot pinpoint an exact code.  Should I use 27599?  Anybody has a thought on this?


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## mbort (May 13, 2009)

I'm lost right along side of you... sooooo...what does he do with these tendons after he harvests them?  Is he doing a tendon reconstruction?  He is just really doing a tenotomy or tenolysis?  (throwing my hands in the air and shakin my head on this one)

Mary, CPC, COSC


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## martnel (May 13, 2009)

I just talked to the anesthesiologist on this case, and he looked through the book with me, and could not find anything that fits (the surgeons never gives us any codes).  He says that this was indeed a very unusual case and he has not seen this done before.  The patient was a colleague's wife, that's why it was agreed on.  The tendons were tossed.  I am using the unlisted then.  Thanks for your time - I do appreciate it much!


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## gomezc (Jun 3, 2010)

There are several busae surrounding the knee.  Two commonly become inflamed and cause knee pain the anserine bursa and the prepatellar bursa.  i would not use 27340 for the pes anserine as the this code is very specific to the prepatellar bursa.  i would code this to unlisted 27599.


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