Orthopedic Coding Alert

Question: Our patient, a 76-year-old female, presented for progressively severe pain in the right hip for which she was extensively treated with steroid injections, physical therapy, and activity modification. The preoperative MRI demonstrated complete disruption of the gluteus minimus and medius tendons. She was operated and the intraoperative diagnosis was a massive soft tissue disruption with rupture of the IT band. Deep bursal biopsies were done. After placing the patient in lateral decubitus position, the following procedures were done in the right hip under aseptic conditions:

• Repair gluteus minimus tendon
• Repair gluteus medius tendon
• Transfer gluteus maximus muscle to the greater trochanter
• Repair IT band

The operative note read as under:

"A standard posterior approach to the hip joint was utilized to gain access to the external rotators and abductor musculature. A sharp incision was made over the greater trochanter. The subcutaneous fat was divided sharply and the IT band was identified. Patient had a large horizontal rupture of the IT band with complete separation of the fibers. IT band was dissected and incised in line with the incision gaining access to the deep aspect of the hip. There was massive soft tissue disruption with complete avulsion of the gluteus medius tendon and partial loss of the gluteus minimus tendon. There was also a small amount of muscle necrosis. Several biopsies were taken from the deep tissue and sent to the lab for permanent section. The extent of the damage was identified and the nonviable tissue was debrided sharply including the bursae.

The gluteus medius tendon was secured with a #2 Fiber wire using a Krakow suture technique. The tendon insertion bed was prepared using a rongeur down to fresh bleeding cancellus bone. Bone tunnels were drilled through the greater trochanter at the lateral aspect of the femoral cortex. A Hewson suture passer was used to pass the sutures over this area so the gluteus medius repair could be tied through bone tunnels. The gluteus minimus was repaired in a similar fashion.

The posterior one third of the gluteus maximus tendon was dissected and detached from its normal insertion site on the posterior aspect of the femur. The tendon edge was secured with a Krakow suture consisting of #2 Fiber wire. It was attached to the apex of the greater trochanter through bone tunnel and tensioned appropriately. The IT band was then repaired directly using a #2 Fiber wire suture.

How do we report this?

New York Subscriber

Answer: There are no tendon repair codes for procedures done at the hip joint, other than those for the hamstrings or quadriceps. You use the unlisted code 27299 (Unlisted procedure, pelvis or hip joint) in the situation described here.