Podiatry Coding & Billing Alert

Question: Our physician performed the following: 

• Primary Repair: split tear peroneus brevis with tubularization, tenosynovectomy, peroneuslongus. 
  
• Debridement and repair. 
  

Which codeis the best choice — 27658 or 28200? 

Arizona Subscriber

Answer: Based on the procedure described above, 27658 (Repair, flexor tendon, leg; primary, without graft, each tendon) is the code that best fits the procedure described. Code 28200 (Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon) requires more work than what you have described above.

Code 27658 is justified if the physician made an incision in the skin of leg over the affected area of flexor tendon injury and he/she cleared off the surrounding tissues from the tendon and identified and debrided the injury/rupture. The tendon was then mobilized and torn ends brought together and re-approximated with sutures maintaining appropriate length and tension. Check the documentation to confirm that no graft was utilized. The physician then closed the skin with sutures.

You can only consider Code 28200 if the procedure involves open repair of torn or ruptured “bending” tendon(s) of foot or toe to restore joints to normal motion. Under local, regional, or general anesthesia, the podiatristmakes an incision over the torn or ruptured flexor tendon of the foot. Surgery could involve the flexor hallucislongus, which bends down the big toe, or the flexor digitorumlongus or its branches that bend down the second, third, fourth and fifth toes (flexion of phalanges II–V). The podiatristsutures the damaged or torn ends of the tendon together before closing the surgical field and applying sterile dressing and a cast, splint or strap to immobilize the affected tendon(s).

Moreover, sincethe physician has mentioned both brevus and longus being involved in the procedure, it is appropriate to use 27658 x 2.