Wiki Tibial Turn Up

[Annes325]

Does anyone have experience with billing/coding for a Tibial Turn Up procedure? I cannot find any coding information regarding this procedure. Our payer is not favorable of the unlisted code. Any information is appreciated.

Thank you!

 

[AlanPechacek]

I have been an Orthopedic Surgeon for over 40 years, and have never used the term Tibial Turn Up for any procedure. Please submit/display the complete Operative Report for me to review, and I will try to help.

Sincerely, Alan Pechacek, M.D.

 

[Orthocoderpgu]

Dr Pechacek does this help you at all ?

The tibia turn-up is another important procedure that is an option in cases of osteosarcoma. The leg is amputated above the knee, and the tibia bone from the lower leg is inverted, or turned up, making it possible for the ankle end of the tibia to be fused to the bottom of the femur. The muscles are then sutured back onto the tibia.

Tibia turn-up is an alternative that people may consider when the appearance of a rotationplasty – a backward foot at the knee position – seems too extreme. Tibia turn-up is also an option when cancer occurs in the thigh, requiring a short above-knee amputation. By having their tibia fused to their femur, these individuals now have a long residual limb that will be easier to fit with a prosthesis and that will provide them with increased function. Although these patients will wear an above-knee prosthesis with a mechanical knee, their comfort and mobility will usually exceed that of above-knee prosthesis users with a short residual limb.

 

[AlanPechacek]

Thanks for the information. I did not do any Orthopedic Oncology, particularly Pediatric Orthopedic Oncology, as a practitioner. This would be highly specialized surgery at a high level center. So, I am not sure how to answer the question of coding it. I looked at several procedural codes, but what it really comes down to is an amputation through the thigh/femur, 27590. The next part is the harvesting of the tibia from the lower leg portion of the amputated leg, then preparing it for re-implantation as a bone "autograft" that is fixed to the femoral stump (I presume with some sort of internal fixation), then the preserved soft tissues of the thigh are "reattached" around it to incorporate it into the now longer thigh. Since the tibia is a bone "graft," in particular a "structural" graft, then +20938 would apply for the harvesting and preparation of the tibia. Beyond that, I can't find any very good or accurate codes for the last part of the procedure (the re-implantation of the tibia to the femur/thigh), so you would probably have to use an Unlisted Code for the Femur (thigh), 27599, plus some Modifiers, 22 at least, possibly 51, or a variant of 59 if one would fit correctly.

I don't know how much this helps you, but I gave it my best shot.

Sincerely, Alan Pechacek, M.D.