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Primary or Secondary Achilles Repair??

Can someone clarify the difference between a primary and secondary achilles repair (27652 vs 27654)?

Supercoder says that a secondary repair, 27654 is when "The provider performs repair of Achilles tendon for the second time with or without use of graft because the previous one was unsuccessful or the patient reinjured the tendon."
But I read elsewhere that a primary repair is when the injury is acute, and a secondary is when the condition is chronic.

I’m trying to code for a patient who injured her achilles over a year ago but hasn’t had it repaired before. So is it primary because this is her first repair, or secondary because the condition is chronic??

Thank you for your help!!

Medical Billing and Coding Forum

Excision of Achilles tendon

Hi everyone,

I am looking for a code for the excision of the Achilles tendon, it was not repaired. Also the plantaris tendon was also excised. Not sure if it would be an unlisted code.

Attention was directed to the left posterior leg where there is an open wound with exposed Achilles tendon. The entire Achilles tendon was resected at least 1-2 cm proximal and distal to the open wound until healthy bleeding was noted within the tendon and there is normal tendon fibers. We essentially had to resect the Achilles tendon off the level of the calcaneus distally and then undermined the wound proximally to resect the proximal 2 cm. Healthy bleeding was noted underneath the tendon. The entire tendon was nonviable. It was sent for pathological examination. A posterior compartment fasciotomy was then performed to expose the flexor hallucis longus muscle belly which was necrotic and nonviable. This portion of the muscle belly was then removed. Plantaris tendon was also removed as it was infected and nonviable. A thorough flush was then performed with 3 L normal saline. After hemostasis was maintained we then applied the Integra biologic skin graft. It was unstable to the wound

Thanks

Medical Billing and Coding Forum

Achilles tendon lengthening

I’m having difficulty in choosing the right combination of codes for these procedures. I believe the haglund excision is 28120. I don’t believe the Achilles debridement is separately billable. For the Achilles lengthening I’m looking at 27685 or 27687, but neither one seems an exact fit.

Procedures: Left Achilles tendon debridement with Haglund excision and Achilles tendon lengthening.

An approximately 10 cm incision was made over the posterior aspect of the heel and was taken down through skin and soft tissue. The tendon was split down the midline, and all degenerative and teninotic debris was excised. We then elevated the tendon from its calcaneal insertion, then used an osteotome and rongeur to removed the prominent haglund deformity and associated bone spurs. We then irrigated the area and tightly reattached the healthy tendon down to the calcaneus using the Arthrex SpeedBridge. We then made a 3 cm incision over the mid posterior calf, protecting the sural nerve and lesser saphenous vein, and made a medial to lateral incision across the gastrocnemius fascia allowing us to lengthen the Achilles approx. 10 degrees. The areas were all then irrigated and closed in layer fashion.

Susan Reinier, CPC

Medical Billing and Coding Forum