# Achilles tendon lengthening



## iowagirl77 (Aug 4, 2017)

I'm having difficulty in choosing the right combination of codes for these procedures. I believe the haglund excision is 28120. I don't believe the Achilles debridement is separately billable. For the Achilles lengthening I'm looking at 27685 or 27687, but neither one seems an exact fit. 


Procedures: Left Achilles tendon debridement with Haglund excision and Achilles tendon lengthening.

An approximately 10 cm incision was made over the posterior aspect of the heel and was taken down through skin and soft tissue. The tendon was split down the midline, and all degenerative and teninotic debris was excised. We then elevated the tendon from its calcaneal insertion, then used an osteotome and rongeur to removed the prominent haglund deformity and associated bone spurs. We then irrigated the area and tightly reattached the healthy tendon down to the calcaneus using the Arthrex SpeedBridge. We then made a 3 cm incision over the mid posterior calf, protecting the sural nerve and lesser saphenous vein, and made a medial to lateral incision across the gastrocnemius fascia allowing us to lengthen the Achilles approx. 10 degrees. The areas were all then irrigated and closed in layer fashion.

Susan Reinier, CPC


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## Orthocoderpgu (Aug 4, 2017)

Looks like a gastroc release was performed (27687).

It's necessary to divide the Achilles in order to get to the Haglund. So the repair of the Achilles tendon is included with the Haglund procedure. However, if there is abnormal pathology of the Achilles tendon, then the Achilles repair may be reported as well.


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## AlanPechacek (Aug 9, 2017)

The above response is generally correct.  The "Haglund Deformity" is an abnormal prominence of the posterior calcaneal tuberosity that results from abnormal growth of the Calcaneal Apophysis during growth and development.  In adults and some children/adolescents, this prominence to which the Achilles Tendon attaches can lead to Calcaneal Bursitis and distal Achilles Tendinitis.  This is often called a "Pump Bump" on the back of the heel, as it is irritated by the shoe heel margin rubbing across the prominence causing swelling, inflammation, and pain.  If it is a severe enough problem, the surgery may be required.  In order to correct the calcaneal deformity, the tendon has to be detached from the calcaneus (as was done in this case), and the boney prominence, +/- any spurs, must be removed.  Any tendon or other soft tissue debridement done would be a part of the procedure.  After the bony prominence has been adequately removed, the tendon has to be repaired back to the calcaneus, as was done here, and which would also be considered a part of the procedure.  The code 28120 is probably more correct for this than 28118 (Ostectomy of the Calcaneus) in that the treatment of "Bossing" of the Calcaneus is consistent with treatment of the Haglund Deformity.  The term "Ostectomy" generally means removal of the entire bone (calcaneus in this case), whereas there is no clear code for "Partial Ostectomy" of the Calcaneus that I would consider applicable to the procedure done here.
     The "Lengthening Procedure" as described in the note is consistent with the Strayer Procedure (also known as the Vulpius Procedure), 27687, which is an "Intramuscular" lengthening as opposed to the more traditional "Achilles Tendon Lengthening" (27685) which is done distally at the tendon level.  I presume that your surgeon lengthened the calf muscle so as to reduce tension on his Achilles Tendon repair to the calcaneus.
     This must have been a long/chronic and severe problem for the patient in order to do this, and I hope it works well for your physician and the patient.

 I hope this discussion helps as well.

Respectfully submitted, Alan Pechacek, M.D
icd10orthocoder.com


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## iowagirl77 (Aug 14, 2017)

Thanks for your responses! Those were the codes I was leaning towards. The confusion came with it being a different version of the gastrocnemius release than what the procedures desk reference describes. The op report describes a smaller incision than the desk reference and there is no mention of separation of the gastrocnemius from the soleus. I appreciate your experience on this. Thanks!

Susan Reinier, CPC


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