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The
Coding Advocate
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CODING
TIP FOR 08/13/2008
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| Ankle
Procedures |
| Have you ever
been out in the yard and stepped in a hole or stepped off
a curb and all of the sudden your foot twists and you feel
a pop and sudden sharp pain in your ankle? Well this inversion
or twisting motion of your foot has caused an ankle sprain.
Now that these ligaments have been injured they are more susceptible
to recurrent or continuous sprains leading to instability
of the lateral or outside portion of your ankle. There are
three collateral ligaments found in this area but it is the
anterior talofibular ligament (ATFL) and calcaneofibular ligament
(CFL) that we are concerned with since these are the primary
restraints and ligaments most commonly associated with in
inversion type injury. A preferred method of repair is a Brostrom
procedure where one or both of the ligaments are sutured in
an end to end fashion and reported with CPT codes 27695 for
one collateral ligament and 27696 for both collateral ligaments.
The Brostrom repair can also be over sewn with the adjacent
retinaculum to supplement and strengthen the repair is what’s
called a Gould modification. Per the AAOS advancement of the
retinaculum is considered part of the Global Service and not
additionally reported. With CPT code 27698 for a secondary
repair the CPT manual gives you an example of a Watson-Jones
while the Coder’s Desk Reference mentions an Evans or
Chrisman-Snook procedure. All of these types of procedures
read more like a reconstruction instead of a repair in that
the peroneus brevis tendon is transected at a more proximal
location up the leg and left attached to its distal point
on the fifth metatarsal tuberosity. In an Evans procedure
the tendon is passed through drill holes in the fibula and
secured, for the Chrisman-Snook the tendon follows the same
path as the Evans but then it is brought down through drill
holes in the calcaneus and then sewn back onto itself in the
area of the talus. The objective of these procedures is to
try and anatomically replicate the position and function of
the ATFL and CFL collateral ligaments. So next time, you may
not know exactly how you stepped down and twisted your ankle
but you’ll know how it can be repaired! |
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