PERONEAL TENDON DEBRIDEMENT w/ EXCISION OF PERONEAL TUBERCLE

[Hvanhyning]

Procedure (per the OP note)
1. Right foot resection of prominent peroneal tubercle, calcaneus (CPT 28120)
2. Right Peroneal longus tendon debridement, removal of low lying muscle belly, distal to tip of the fibula (CPT 28200)
3. Right foot debridement of peroneal brevis tendon (CPT 28200)

The surgeon removes the peroneal tubercle with a rongeur and smooths with a rasp to remove any rough edges. He incises the tendon sheath, and there is significant thickening of the sheath. He then appears to extensively debride the peroneus longus and brevis tendons for moderate tendinosis, moderate synovitis, scar tissue, no tearing to either tendon. Some thickening of the peroneal tendon sheath was excised. All unhealthy portions of tendon sharply debrided with a 15-blade.

CPT 28200 is for repair of tendon. I am not seeing repair here. I'm thinking CPT 28086 (Synovectomy, tendon sheath, foot, flexor) instead. Any other advice/suggestions?

Thank you!

 

[AlanPechacek]

I agree with you that 28200 is probably not correct as it applies to "tendon repair," which according to your note is not what he did. He did do "excision of lesions of the tendons" with his debridement of the tendons, he "excised lesions of the tendon sheaths" (synovitis, and thickened and inflamed portion of tendon sheath). Although there was no "cyst or ganglion" type of lesion, I think 28090 more accurately describes/fits his procedure as described.

Respectfully submitted, Alan Pechacek, M.D.
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