# achilles tendon repair?



## BFAITHFUL (Dec 5, 2010)

our doc performed an achilles tendon repair with a PRP matrix graft and he seems to think because he used the PRP, that now he can use CPT 27652 which is a repair with graft, but PRP is not really a graft it's just platelet rich plasma (blood), it's not a tissue graft or tendon graft.  I'm leaning more towards CPT 27650?    Thanks

DX:  Rupture of right Achilles tendon

Procedure:

A medial incision was made along the achilles tendon.  Skin flaps were minimally elevated.  The tendon was left with its paratenon and was irrigated out with normal saline.  Grabbing the proximal portion, a whipstitch was placed just distal to the myotendinous junction until the end.  The whipstitch was then cut and the needle was removed leaving 2 inches for suturing.  This was performed at the distal end starting from distal to proximal and then cutting the suture with the knee in flexion and the foot in equinus.  The sutures wer then tied with a surgical knot with a well secured repair.  The leg was then placed on the table, irrigated out again, and a PRP matrix was then sutured with 4-0 Vicryl interrupted sutures over the repair line.


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## capricew (Dec 5, 2010)

bfaithful said:


> our doc performed an achilles tendon repair with a prp matrix graft and he seems to think because he used the prp, that now he can use cpt 27652 which is a repair with graft, but prp is not really a graft it's just platelet rich plasma (blood), it's not a tissue graft or tendon graft.  I'm leaning more towards cpt 27650?    Thanks
> 
> dx:  Rupture of right achilles tendon
> 
> ...



you are correct that a prp is not a graft, however, you may want to clarify/query your doctor as he stated that the prp matrix was sutured over the repair when typically it is injected into the operative site.  Is this an allograft (donor),  if he sutured something over the repair site, it is a graft.

The good news is that there is a catergory 3 code for this prp injection in 2011   it is 0232t.

At this time, i cannot advise which codes are more appropriate as the op note is misleading that an actual graft was placed over the repair site.  If this is the case then the doctor is correct.  If it was just a prp, by injection, then you are correct with 27650.


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## BFAITHFUL (Dec 6, 2010)

I guess I'm still thinking PRP is just that ....Platelet rich plasma obtained from patient's own blood, at the end of the day.. it's still just that "blood" which should not be looked upon as being a graft whether injected for sutured on.   It doesn't look like it's an allograft because I bill for the ASC & after further review I see they gave me an invoice for a "Cascade Autologous Platelet System"  
Thanks your help


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## BFAITHFUL (Dec 6, 2010)

Op note also states   "skin was closed with 4-0 nylon interrupted sutures.  The PRP solution was injected into the tendon.  A sterile dressingwas applied with a well padded posterior splint in equinus"

Sorry I missed the 2nd page of note before...
Thanks


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## kathydaniel (Dec 7, 2010)

0232T but it probably won't be reimbursed.  I haven't found an insurance carrier that will pay for PRP injections.


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## BFAITHFUL (Dec 7, 2010)

right... but going back to my original question.. which is whether to use 27650 or 27652 because I don't think using PRP would justify as a graft for cpt 27652

thank you


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## kathydaniel (Dec 8, 2010)

I would probably go unlisted and compare to 27652.  Here's an article on PRP Matrix grafts - http://www.prolotherapy.com/PPM_JanFeb2008_Crane_PRP.pdf


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