# Coding for LLD (Limb Lengthening Discrepancy) Treatment Procedures



## mholley (Jan 23, 2018)

Any one with experience in coding for LLD treatments?  Looking to understand the variety of methods used i.e. for shortening/lengthening and any associated procedures involved with skin/tendon/musculature revisions.  Please reach out to marilyn.holley@hrscoding.com


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## AlanPechacek (Jan 23, 2018)

The procedure for dealing with *Leg Length Discrepancy (LLD)* is termed *Osteoplasty. * Depending on where the discrepancy is located (thigh, lower leg, or both) determines whether the bones are lengthened or shortened.  Lengthening is more commonly done than shortening.  For the *Thigh/Femur*, *22465* is for *Osteoplasty of the femur with shortening*, and *22466 is for femoral lengthening.*  For the *Lower Leg/Tibia and Fibula*, *27715* covers both *shortening and lengthening*.  These apply basically to the boney structures.  The soft tissues (muscle, tendons, nerves, and blood vessels) are not always treated surgically.  In lengthening procedures, the process of gradually lengthening the bone is so slow that these tissue are generally allowed to stretch out and lengthen along with the bone.  All of them have to be monitored very closely, particularly the nerves and vessels, during this process, and if problems arise for nerves or circulation, then the process has to be slowed even more, or stopped completely if the viability of the lower leg and foot are threatened.  Tendon lengthening procedures may have to be done at some point along the way, maybe at the beginning, but more likely if they don't seem to be lengthening well as the bone is lengthened.  The codes for tendon or muscle lengthening are in *Repair, Revision and/or Reconstruction* coding sections.

Hopefully this information helps.

Respectfully submitted, Alan Pechacek, M.D.


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## jessieraebaker (Feb 22, 2018)

AlanPechacek said:


> The procedure for dealing with *Leg Length Discrepancy (LLD)* is termed *Osteoplasty. * Depending on where the discrepancy is located (thigh, lower leg, or both) determines whether the bones are lengthened or shortened.  Lengthening is more commonly done than shortening.  For the *Thigh/Femur*, *22465* is for *Osteoplasty of the femur with shortening*, and *22466 is for femoral lengthening.*  For the *Lower Leg/Tibia and Fibula*, *27715* covers both *shortening and lengthening*.  These apply basically to the boney structures.  The soft tissues (muscle, tendons, nerves, and blood vessels) are not always treated surgically.  In lengthening procedures, the process of gradually lengthening the bone is so slow that these tissue are generally allowed to stretch out and lengthen along with the bone.  All of them have to be monitored very closely, particularly the nerves and vessels, during this process, and if problems arise for nerves or circulation, then the process has to be slowed even more, or stopped completely if the viability of the lower leg and foot are threatened.  Tendon lengthening procedures may have to be done at some point along the way, maybe at the beginning, but more likely if they don't seem to be lengthening well as the bone is lengthened.  The codes for tendon or muscle lengthening are in *Repair, Revision and/or Reconstruction* coding sections.
> 
> Hopefully this information helps.
> 
> Respectfully submitted, Alan Pechacek, M.D.



I think there's a little dyslexia on the codes. Should 22465 and 22466 be 27465 and 27466?


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## tmtolbert (Oct 30, 2018)

*Bone Lengthening Procedures*

The Precise representative informed us that the osteoplasty codes (ex. 27466 femur) do not cover the insertion of the intramedullary nail.  He states we should separately bill an open fracture treatment code for that particular bone (ex. 27506 femur).  I am not finding any documentation that supports this.  Have any of you ever heard of this practice? 

Thanks,

tmtolbert


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