# Lateral open ligamen reconstruction



## nabernhardt (Sep 9, 2011)

We just started with an orthopedic surgeon and am asking for help with this procedure please (CPT codes) I am thinking 29895 and 27696?  Thanks for everyones help.

PREOPERATIVE DIAGNOSIS: Left ankle instability with possible OCD, possible
peroneal tendon tear.
POSTOPERATIVE DIAGNOSIS:
1. Synovitis left ankle.
2. Lateral ankle ligamentous instability.
OPERATION:
1. Left ankle arthroscopy with partial synovectomy.
2. Lateral open ligament reconstruction.


PROCEDURE: The patient was taken to the operating room, placed under general
anesthesia. Limb was prepared with alcohol and DuraPrep, draped in several layers.
Instability was confirmed. Limb was exsanguinated, tourniquet was elevated. Anterior
medial portals established. She had a large flap of inflamed synovitis in the anterior
lateral gutter. I probed her cartilage in the plafond and the lateral talar dome were soft
but no unstable flaps. I checked both medial and lateral gutter and posterior. Attention
was drawn to the lateral ankle. A curved incision was made. Superficial structures
sharply dissected. Redundant ligaments were released off to the anterior lateral and distal
fibula. I inspected the peroneals. There was a small tear in the peroneus brevis that was
kind of a flap that was trimmed. No longitudinal tears. I prepared the fibula to a
bleeding base, placed two TwinFix anchors and used a locking suture configuration to
embrocate about a centimeter of the anterior talofibular and calcaneofibular ligaments
and then in reinforced it overlapping. The wound was irrigated. Tourniquet was
deflated. A two-layer closure was applied with the foot held in the everted position.


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## johnmeyer (Sep 11, 2011)

Let me preface my reply with… I’m not a certified coder yet because I’m still in school for billing and coding. I am set to graduate soon and I have practical experience in at least successfully auditing for an Orthopaedic doc while on a 120 hour externship.

That being said, I think you’re right to use 29895 for the arthroscopic partial synovectomy and 27696 for the ligament reconstruction since the lateral and medial collateral ligaments are involved, thus both collateral ligaments.


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## nabernhardt (Sep 11, 2011)

thank you I appreciate your response I'm just trying to understand this for sure how do you tell if it was one or both collateral ligaments?


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## nabernhardt (Sep 19, 2011)

ok I'm rethinking this for the lateral open ligament reconstruction wouldn't it just be for the lateral ligament and not both so maybe I should use 27695 instead?


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