“Can anyone please explain the CPT codes for retrocalcaneal surgical treatment? Specifically, the combination of codes that can billed for this pathology.
1. Secondary repair of Achilles tendon
2. Resection of a Haglunds deformity
3. Resection of posterior calcaneal spur.”
So, surgery is being performed on the posterior aspect of the calcaneus. A Haglund’s deformity and a retro calcaneal exostosis are both present. In order to gain access to the two osseous pathological issues that are present, the Achilles tendon needs to be detached from the calcaneus and then re-attached after the procedure set is complete. If the Achilles tendon is only being addressed in this fashion, a billable procedure is not being performed. However, if the Achilles tendon is found to be damaged and a repair needs to be performed, this is certainly a billable procedure. The most appropriate CPT code to bill would be 27654 which is defined as: Repair, secondary, Achilles tendon, with or without graft.
What about the Haglund’s deformity and the retro calcaneal exostosis? The most appropriate CPT code to bill for the removal/excision of either of these osseous abnormalities is CPT code 28118 which is defined as: Ostectomy, calcaneus. The problem is that this procedure needs to performed and billed for twice on the posterior aspect of the calcaneus. When the Medically Unlikely Edits are accessed, CPT code 28118 has a MUE value of 1. Therefore, in the scenario stated in the above post, CPT code 28118 can only be billed one time.
As far as the coding scenario is concerned, CPT codes 28118 and 27654 are not bundled within the NCCI edits. Therefore, the most appropriate coding scenario would be the following:
CPT 27654- RT/LT
CPT 28118 – 59, RT/LT
This is my opinion.
Michael G. Warshaw
DPM, CPC
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