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I usually use cpt code 28118 for Haglund's deformity on the calcaneaus, if more extensive like more amount of bone is taken then I use 28120. Dr. wants to use cpt code 28120. Any thoughts on this one?
The operative extremity was exsanguinated followed by inflation of the tourniquet to 275 mmHg. An incision was created along the posterior aspect of the
Achilles tendon going through skin, subcutaneous tissue followed by peritenon to fully expose the posterior aspect of the Achilles tendon. A midsubstance incision
was made through the middle of the Achilles tendon full-thickness all the way down to the level of bone. The tendon was elevated off the calcaneus both medial
laterally leaving tissue intact at the far extremes of the insertion. At this point an osteotome was removed used to remove the Haglund deformity of the
calcaneus and a partial excision of bone was performed. A power rasp was used to smooth down the posterior aspect of the bone to not leave any type of
prominence. A posterior fasciotomy was created of the deep compartment in order to promote blood flow to the area and release the contracture on the
posterior ankle. At this point the debridement was performed of the Achilles tendon with removal of significant scar tissue. Following completion of the
debridement there was more than 50% of good tendon remaining so was decided that an FHL transfer would not be needed.
At this point drill holes were placed in the calcaneus both proximally and distal rows and anchors were placed in the proximal row and secured the tendon. A 0
Vicryl suture was used to repair the tendon in secondary fashion along its mid substance and then the distal row of anchors were used to secure the crossing
suture bridge. The foot was placed into full plantar flexion following placement of the distal row of anchors. Following this the area was irrigated and then the
peritenon was closed using 3-0 Monocryl suture followed by closure of the subcutaneous tissue using 3-0 Monocryl suture followed by 3-0 nylon suture for the
skin. The foot was washed and dried and the patient was placed into a sterile dressing consisting of Xeroform, 4 x 4's, ABD pads followed by sterile nonsterile
Sof-Rol followed by plaster posterior splint in slight plantarflexion but tension on the repair followed by overwrapping it with an Ace bandage. The tourniquet was
then taken down.
The operative extremity was exsanguinated followed by inflation of the tourniquet to 275 mmHg. An incision was created along the posterior aspect of the
Achilles tendon going through skin, subcutaneous tissue followed by peritenon to fully expose the posterior aspect of the Achilles tendon. A midsubstance incision
was made through the middle of the Achilles tendon full-thickness all the way down to the level of bone. The tendon was elevated off the calcaneus both medial
laterally leaving tissue intact at the far extremes of the insertion. At this point an osteotome was removed used to remove the Haglund deformity of the
calcaneus and a partial excision of bone was performed. A power rasp was used to smooth down the posterior aspect of the bone to not leave any type of
prominence. A posterior fasciotomy was created of the deep compartment in order to promote blood flow to the area and release the contracture on the
posterior ankle. At this point the debridement was performed of the Achilles tendon with removal of significant scar tissue. Following completion of the
debridement there was more than 50% of good tendon remaining so was decided that an FHL transfer would not be needed.
At this point drill holes were placed in the calcaneus both proximally and distal rows and anchors were placed in the proximal row and secured the tendon. A 0
Vicryl suture was used to repair the tendon in secondary fashion along its mid substance and then the distal row of anchors were used to secure the crossing
suture bridge. The foot was placed into full plantar flexion following placement of the distal row of anchors. Following this the area was irrigated and then the
peritenon was closed using 3-0 Monocryl suture followed by closure of the subcutaneous tissue using 3-0 Monocryl suture followed by 3-0 nylon suture for the
skin. The foot was washed and dried and the patient was placed into a sterile dressing consisting of Xeroform, 4 x 4's, ABD pads followed by sterile nonsterile
Sof-Rol followed by plaster posterior splint in slight plantarflexion but tension on the repair followed by overwrapping it with an Ace bandage. The tourniquet was
then taken down.