Orthopedic Coding Alert

Question: Our surgeon excised a portion of the patient's Achilles tendon, reanastomosed the tendon using running sutures, and then used the TOPAZ procedure to augment the repair. The patient's tendon wasn't torn or ruptured. How should we code this procedure?

California Subscriber

Answer: Because the tendon in this case isn't torn or ruptured, you should report 27680 (Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon). CPT includes several codes for Achilles tendon repair, so know how to differentiate them according to your case. Keep these guidelines from the American Orthopaedic Foot and Ankle Society (AOFAS) in mind:

• For debridement of insertional Achilles tendinitis and repair (suture anchor versus bony trough), choose code 27680.

• For Achilles tendon debridement and repair for tendonosis, choose 27654 (Repair, secondary, Achilles tendon, with or without graft).

• For Achilles tendon debridement with FHL transfer and tenodesis FHL to FDL, choose 27680 and 27691 (Transfer or transplant of single tendon [with muscle redirection or rerouting]; deep [e.g., anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot).

• For repair of the Achilles tendon to calcaneus for traumatic avulsion, choose 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon).

Definition: TOPAZ is a new micro-ablator technique for soft tissue procedures. According to CPT Assistant, consider the TOPAZ as any other technique and code accordingly -- by choosing the most accurate code from the above list.