# Any Foot and Ankle Guru's?



## VIOLYNPLA2 (Apr 14, 2009)

My Physician has been billing for "excision of low lying peroneus brevis muscle 
belly" along with " Ankle ligament reconstruction and repair of peroneal retinaculum" and we are receiving denials using the debridement as well as the unlisted code. He insists that excision of muscle belly should be reimbursed. Any input would be appreciatied.

Operation: 1.Left ankle lateral ankle ligament reconstruction using graft augmentation
2. Repair of peroneal retinaculum.
3. Excision low lying peroneus brevis muscle belly 

Procedures: 27698, 27675, 27899

This is an excerpt....

On inspection of the peroneal tendons, they were thickened and full. Upon making an incision overlying the peroneals, there was a large engress of fluid and there was large thickened, abundant, chronic tendonitis present. At this point, prior to reconstructing the lateral ankle ligaments, we inspected the peroneal tendons. We debrided this gross amount of thickened chronic tendonitis . We then inspected the peroneal tendon themselves. There was a large low lying peroneus brevis muscle which extended at and even distal to the tip of the fibula through the peroneal retinaculum. At this point this low lying peroneus brevis was then debrided and it was debrided from distal to proximal so that when we completed our debridement of this low lying muscle we could take the peroneal tendons through a full range of motion.
After debriding the low lying peroneus brevis muscle and the exuberant thickened, chronic tenosynovitis, we then retracted the peroneal tendons inferiorly so again we could gain access to reconstruction or our lateral ankle ligaments.................

Is excision of the low lying muscle belly a billable service....................

Your thoughts appreciated.:


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## coderguy1939 (Apr 14, 2009)

27675 sounds like much more than debridement to me.  AAOS guidelines include transfer and mobilization of adjacent retinaculum and tenolysis and/or tenosynovectomy except for a different pathological diagnosis as part of 27698.  I'm not sure if low lying peroneus brevis muscle belly will get you there. The lay description of 27698 allows for a number of different techniques for the ligment repair which may include the additional work the doctor is doing.  Any other opinions?


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## VIOLYNPLA2 (Apr 17, 2009)

Thanks CoderGuy


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