# Haglund's with bursectomy



## akalb (Jul 17, 2012)

Hello all.  I am struggling with this operative report.  This is definitely 28118, but the surgeon also did an excision of inflammatory tissue.  I am struggling with 11043 or is this included in the 28118?  According to CCI edits these can be billed together.  There was no repair of the achilles tendon.  Se redacted note below.  Thank you for your help!

*A longitudinal incision was made just anterior to the Achilles tendon, positioned to allow for visualization of the posterior prominence of the calcaneus and the retrocalcaneal space.
Careful dissection was carried out to identify the retrocalcaneal tissues,
the Achilles tendon, and the calcaneus itself.  Extensive inflammatory
response was present in the retrocalcaneal area with findings consistent
with chronic retrocalcaneal bursitis and Achilles tendinosis.  The Achilles
tendon was carefully examined.  No significant injury to the tendon was
noted, although there were some areas of degenerative changes in the
connection to the retrocalcaneal area.  Most of the reaction seemed to be
around the prominent posterior calcaneus with the posterior tuberosity
impinging on the retrocalcaneal bursa and on the Achilles, especially with
dorsiflexion.  A combination of powered saw, rasp, and Rongeurs were
utilized to smooth the calcaneus and remove the bone while maintaining the
Achilles insertion that the tendon.  In this fashion it was not necessary
to do any kind of Achilles reconstruction.  The reactive inflammatory
retrocalcaneal tissue was also removed.  The surgical site was thoroughly
irrigated.  Bone was placed over the raw bone edges and the tourniquet was
released to optimize hemostasis postoperatively.*


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## christinnagle (Jul 18, 2012)

11043 would be inappropriate since it is for debridement down to muscle, fascia (which includes skin/subq tissue).
Maybe you could use mod 22 for the debridement, if the doc feels it was more work than typical for this type of case.


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