kwinters
Contributor
Any foot/ankle coders out there using 28118 for excision of haglunds deformity and icd 10 M95.8 for the diagnosis??
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Wiki Haglund's deformity
- Thread starter kwinters
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We use CPT 28120 for an excision of a Haglunds deformity and M92.6_ for the diagnosis. We use CPT 28118 if a posterior heel spur was excised or if an excision of a Haglund deformity and retrocalcaneal bursa was performed.
nsteinhauser
Expert
What does the op note say for dx? If it's a calcaneal spur, you could use M77.31 (rt) or M77.32 (lt). Also look in the op note for work done on the Achille's. That can sometimes be separately coded, depending on if you follow AHA or AMA guidelines.
kwinters
Contributor
There was also a posterior calcaneal bone spur excised (28119) & a plantar fascial release (which is included in 28119). I've attached the op note if you'd like to see it. I guess I'm just slightly confused as to which CPT to really be using for haglunds deformity as I've always used 28118 w/ dx M95.8.
kwinters
Contributor
****see attached op note***
But yes he also removed a posterior calcaneal bone spur & did a plantar fascia release (28119)
nickelclaw
True Blue
The difference between 28118 and 28119 is heel spur. 28118 is for unspecified spur or just dx of Haglund's but calcaneal spur not mentioned
Where as the 28119 description in the coder desk reference is calcaneal spur w/wo plantar fascia release.
This is what I came up with:
27654 Achilles debridement due to tendonitis codes to the repair secondary for Achilles
27687 gastrocnemius recession
28119
64726 decompression of plantar digital nerve
Where as the 28119 description in the coder desk reference is calcaneal spur w/wo plantar fascia release.
This is what I came up with:
27654 Achilles debridement due to tendonitis codes to the repair secondary for Achilles
27687 gastrocnemius recession
28119
64726 decompression of plantar digital nerve
kwinters
Contributor
I greatly appreciate your review and assistance w/ this op note. So just to clarify, I'm not going to code the haglund, right?
nickelclaw
True Blue
correct due to heel spur removed code the 28119
you are welcome
you are welcomekwinters
Contributor
You're awesome!! Thanks againcorrect due to heel spur removed code the 28119
amyjph
True Blue
Yes, if you are talking straight Haglund's (aka pump bump, etc) and that's all that was done it's 28118. When you start adding in exostosis (calcaneal spur separate area from a Haglund), bursitis, Achilles work, bursa and other things then you get into other CPT choices. It depends on location. The heel spur is more on the bottom of the calcaneus where the weight bearing area is. That's why the plantar fascial release is included in 28119. Haglund is on the posterior (back) area where the Achilles inserts.
28120 is usually performed for an infection and not an exostosis. It is a deeper "scoop" "crater" made in the bone and not just shaving off the exostosis. There's a divot remaining and a lot of times they put bone wax or something else in to fill it.
These are always a little different depending on what other procedures were done at the same time. There's usually other problems going on and not just a straight 28118, but it does happen.
28120 is usually performed for an infection and not an exostosis. It is a deeper "scoop" "crater" made in the bone and not just shaving off the exostosis. There's a divot remaining and a lot of times they put bone wax or something else in to fill it.
These are always a little different depending on what other procedures were done at the same time. There's usually other problems going on and not just a straight 28118, but it does happen.
pwebbabshire@cox.net
Networker
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I realize this is an old post but if this helps someone on this issue it is worth posting. This is from CPT Asst. This assures you that cpt code 28118 is the one to use in most cases for Haglund's deformity. I code this pretty often and there is not a problem coding cpt code 28118 for Haglund's Deformity.
Surgery: Musculoskeletal System
Question: The patient was diagnosed with retrocalcaneal bursitis and Haglund’s deformity of calcaneus. An incision was made along the lateral aspect of the distal Achilles tendon and the tendon was reflected thereby exposing the calcaneus. The retrocalcaneal bursa was excised. Next, an osteotome was used to remove the Haglund’s deformity down to the Achilles insertion. A rasp was used to ensure that there were no residual osseous spurs. Debridement of the necrotic area of the Achilles tendon was performed, and the incision was closed in layers with sutures. Is it appropriate to report CPT code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, for this procedure?
Answer: No. If a Haglund’s deformity of the heel and retrocalcaneal bursa were removed, then code 28118, Ostectomy, calcaneus, should be reported. If additional work other than for exposure was performed on the Achilles tendon, then that service would be reported as 28200, Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon. If there is a spur on the bottom of the foot and a plantar fascial release is performed, then code 28119, Ostectomy, calcaneus; for spur, with or without plantar fascial release, would be reported instead of/in addition to 28118. Code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, is typically performed for an infection and not for an exostosis, and only if a partial excision of the heel is performed.
CPT Assistant article:
Fri 5/24/2024 10:27 AM
Surgery: Musculoskeletal System
Question: The patient was diagnosed with retrocalcaneal bursitis and Haglund’s deformity of calcaneus. An incision was made along the lateral aspect of the distal Achilles tendon and the tendon was reflected thereby exposing the calcaneus. The retrocalcaneal bursa was excised. Next, an osteotome was used to remove the Haglund’s deformity down to the Achilles insertion. A rasp was used to ensure that there were no residual osseous spurs. Debridement of the necrotic area of the Achilles tendon was performed, and the incision was closed in layers with sutures. Is it appropriate to report CPT code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, for this procedure?
Answer: No. If a Haglund’s deformity of the heel and retrocalcaneal bursa were removed, then code 28118, Ostectomy, calcaneus, should be reported. If additional work other than for exposure was performed on the Achilles tendon, then that service would be reported as 28200, Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon. If there is a spur on the bottom of the foot and a plantar fascial release is performed, then code 28119, Ostectomy, calcaneus; for spur, with or without plantar fascial release, would be reported instead of/in addition to 28118. Code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, is typically performed for an infection and not for an exostosis, and only if a partial excision of the heel is performed.
CPT Assistant article: