Orthopedic Coding Alert

Question: Operative notes indicate that the provider repaired a patient's Achilles tendon with a graft. I looked in the CPT® book and noticed that there were three Achilles tendon repair codes. Which one should I choose?

Minnesota Subscriber

Answer: You'll need to check the op report for more information, or check with the provider, to dig out more encounter specifics. There are three Achilles tendon repair codes, which you'll use as the notes dictate:

• 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon). Use this repair code when the provider performs a primary repair on a patient's Achilles tendon without a graft.
• 27652 (... with graft (includes obtaining graft)). Use this repair code when the provider performs a primary repair on a patient's Achilles tendon with a graft. According to Codify, the provider performs a graft to "repair or replace defective or missing tissue or structure with another material; repair of defects in body structures; artificial material, skin, part of a vessel, bone, or other tissue harvested and placed over or in a defect or used for anastomosis, i.e., to surgically connect two structures together." Remember that you can only report this code when the surgeon performs the harvest and autograft; if she uses an allograft tendon, you cannot report 27652.
• 27654 (Repair, secondary, Achilles tendon, with or without graft). Use this repair code when the provider performs a secondary repair on a patient's Achilles tendon. Use 27654 regardless of whether the provider performs a graft. According to Codify, a secondary repair occurs when "the provider performs repair of Achilles tendon for the second time with or without use of graft because the previous one was unsuccessful, or the patient reinjured the tendon."

Best bet: Check the op notes and the patient's medical record, and then ask the performing provider, to find out if this is a primary or secondary repair, and whether the provider performed a graft in addition to the Achilles procedure. Then, choose the appropriate code.