# Plantar Fascia Tenotomy with Topaz



## dyoungberg (May 3, 2012)

Our Dr performed the following surgery and I'm having difficulty coming up with coding.  Has anyone had to bill this out before and what coding did you use?  I'm leaning towards unlisted.

_PREOP DIAGNOSIS:   RIGHT FOOT CHRONIC RECALCITRANT PLANTAR FASCIITIS  
POSTOP DIAGNOSIS:  SAME 

PROCEDURE:   RIGHT PLANTAR FASCIA TENOTOMY WITH TOPAZ RADIOFREQUENCY WAND 

ANESTHESIA:  GENERAL ET 

INTRODUCTION:  Routine preop evaluation revealed no medical contraindication to surgery. The patient and family were consulted at length regarding the relative risks, benefits, and alternatives of the above elected procedure. They understood these risks to include but not be limited to infection, sepsis, osteomyelitis, DVT, PE, stroke, MI, death, nerve or blood vessel damage, RSD, persistent pain, stiffness, requirement for future operative intervention, among others. Understanding all the above risks and that no guarantees were made nor implied, the patient freely consented to proceed. 

OPERATIVE PROCEDURE: Patient was taken to the operating room on 5/2/12 where she was transferred to the OR table and placed in the supine position without event. She was induced under general anesthesia and intubated via the ET route. Prior to initiation of the operative procedure, the American Academy of Orthopedic Surgeons' timeout protocol was instituted. This assured the patient's name, the correct extremity, the correct side, the patient's allergies, their preoperative medications and antibiotics. Following completion of the appropriate timeout and verification of all the above, we proceeded with the operative procedure. The patient received 1 gram Ancef as antibiotic preop prophylaxis in preoperative holding. A tourniquet was placed about the right proximal thigh. All bony prominences were carefully and thoroughly padded. The head and neck were secured in neutral position. The RLE was prepped and draped in the usual sterile fashion. The limb was exsanguinated with a sterile Esmarch bandage. The tourniquet was inflated to 250 mm's mercury. 

A 2.0 cm longitudinal skin incision was made on the medial plantar aspect of the heel just distal to the plantar fascia origin. Dissection was carried down to the plantar fascia. Visualization of the medial half of the plantar fascia was obtained. Utilizing the Topaz RF wand, 15 perforations were created into the plantar fascia, pie-crusting the plantar fascia in the desired manner. The wound was then irrigated with normal saline and closed with 3-0 Monocryl subcuticular sutures, followed by 3-0 nylon vertical mattress sutures. A bulky compressive dressing was applied with a postop shoe.
The patient was extubated in the OR and returned to recovery in good condition. There were no noted complications. Sponge, needle and instrument counts were correct at the end of the operative procedure. EBL was minimal. Tourniquet time was 10 minutes. _


Thanks!


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## PLAIDMAN (May 11, 2012)

*topaz*

Sorry, this is a little late.

The Topaz company recommends that you use the CPT code of the procedure you are doing(ex:achilles tendon repair code)....or use unlisted foot code,  Topaz is a tool not a procedure.  However I did research some payor policy and found many major commercial payors deem the use of this tool experimental and will not cover it.

You should check your specific payor policy on the use of this tool.


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## miracle01 (May 11, 2012)

Topaz micro debrider is a tool which utilizes coblation technology to perform a small incision in the fascia and is considered an alternative to the use of standard surgical instruments such as scalpels, low frequency electrocautery etc.  Code selection is choosen by procedure performed and specific anatomy involved.  The appropriate code should be selected based on the definitvie procedure being performed as described in the code discriptor. - AMA CPT Assitant Sept 2009 Vol 19 Issue 9


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