# Achilles repair help!



## ebarker33 (Jan 15, 2015)

I have the Tenex tenotomy procedure (27605-LT), *but is there a CPT code besides 17999 for the application of the Skye ExtraCellular Matrix*? 

Any help would be GREATLY appreciated!!

PREOPERATIVE DIAGNOSIS:  Painful Achilles tendonitis of the left.

POSTOPERATIVE DIAGNOSIS:  Painful Achilles tendonitis of the left.

OPERATION:  Tenex tenotomy procedure to the left Achilles tendon with Skye  ExtraCellular Matrix application.

ANESTHESIA:  Monitored anesthesia care with 10 mL of a 1:1 mixture of 1% lidocaine plain and 0.25% Marcaine plain.

ASSISTANT:  None.

HEMOSTASIS:  None.

ESTIMATED BLOOD LOSS:  Less than 3 mL.

MATERIALS USED:  4-0 Prolene.

INJECTABLES:  2.0 mL of Skye ExtraCellular Matrix.

INDICATION FOR THE PROCEDURE:  This 57-year-old female had presented to my office complaining of pain in her left Achilles tendon for some time.  She had failed conservative treatment which consisted of physical therapy, as well as an offloading Cam walking boot, anti-inflammatories, as well as a Medrol Dosepak.  Conservative treatment has been attempted for several months without avail.  The patient wishes to proceed with the elective procedure as stated above.  This was discussed with her several times in the past and she feels now the pain in her Achilles tendon has inhibited her every day activity.   

All risks, complications, and alternative treatments to the procedure were discussed with the patient and the patient's questions and concerns were answered at this time.  There are no apparent contraindications to the procedure at this time.

DETAILS OF OPERATION:  The patient was brought into the operating room and placed on the operating table in the lateral position. The left foot and ankle were then prepped, scrubbed, and draped in the usual aseptic manner.  Following IV sedation, local anesthesia was obtained utilizing 10 mL of a 1:1 mixture of 1% lidocaine plain and 0.25% Marcaine plain. 

Attention was then directed to the patient's most painful area, the posterior medial Achilles tendon.  The Tenex procedure was utilized under ultrasound guidance to address the underlying thickened Achilles tendon.  The anatomy was identified and the diseased tissue was confirmed utilizing ultrasound guidance. 

A #11 blade was used to incise the skin and the blade continued through the subcutaneous tissues and incised the tendon or fascia.  This facilitated the entry of the Tenex MicroTip into the diseased tissue of the tendon.  The thickened Achilles tendon was noted to become more normal tissue appearance after the Tenex procedure was applied.   *In addition to the Tenex, 2 mL of Skye ExtraCellular Matrix was injected about the area as an adjunct to the tendon repair.*  The patient tolerated the procedure and anesthesia well.  No postoperative block was given at this time.  The incision was reapproximated and coapted utilizing 4-0 Prolene in a simple interrupted suture technique.  Steri-Strips were then applied as well as an Opsite.


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