# Any foot and ankle specialists out there - HELP!!!!



## skorkfranks (May 27, 2011)

One of my Docs is now doing foot and ankle. I have the following OP note and I'm not sure what I'm looking at. Dr. provided the following codes:

Dx codes - 736.72, 718.47, 344.30, 736.74

CPT codes - 27691, 27690x2, 28250, 27680

I see that 27690 and 27680 are bundled into 27691, but Dr. says that these were done through separate incisions. 28250 is listed as a separate procedure. Here is the OP note. 
Any help with intepreting this is appreciated. Also, does anyone know of any articles pertaining to coding foot and ankle. Thanks!!!!

OP note:

OPERATION:  Right heel cord lengthening, split anterior tibialis tendon
transfer, transfer of the FDL into the calcaneus and plantar releases.

SKIN PREP:  ChloraPrep.

PROCEDURE IN DETAIL:  Following discussion of risks, benefits, alternative
treatment of surgical and non-surgical, the patient consented to surgery.
Prior to incision, the patient received antibiotics.  Following induction of
anesthesia, the patient's leg was prepped and draped in the usual sterile
fashion.  The heel cord was used through a small head resection.  The heel
cord was fractionally lengthened in a percutaneous fashion.  The attention  was
then turned.  The incision was made over the medial border of the foot to  the
level of the first ray exposing the master knot of Henry, the FDL as well  as
FHL were lengthened at this level.  Through the incision just posterior to  the
medial malleolus, the FDL tendon sheath was identified and then the FDL  was
pushed up to this medial incision.  Tunneled subcutaneously to the medial
border of the calcaneus, a 5-mm drill tunnel was used to drill the tunnel
transcalcaneally.  The FDL tendon was rather into this hole and secured using
1.0 bioabsorbable screw.  Attention was then turned to the dorsal medial
aspect of the foot.  The tibialis anterior tendon sheath was exposed.  The
lateral half of the tibialis anterior tendon was harvested, and going down
through the proximal incision, rather to the lateral aspect of the foot and
then tunneled at the level of the cuboid from lateral to medial.  The split
anterior tibialis tendon was inserted into this tunnel and secured using one
7.0 bioabsorbable Milagro screw.  Upon termination of procedure, the foot was
in neutral stance position with good attitude of the foot.  Tourniquet was  let
down.  Hemostasis was obtained.  Foot was wrapped in a cane of pink.  The
wounds were closed using Vicryls, Monocryls, and Biosyn.  A well-padded and
well-molded compression short-leg cast was applied with bivalved.  The  patient
was then transferred to recovery unit in stable condition.


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