Repair of chronic achilles rupture w/FHL tendon graft

Hi, Need some clarification on the repair of chronic achilles rupture. My understanding is that the primary repair (27650) is for use when it is a new rupture and that the secondary repair (27654) is for a chronic tear. Now per Supercoder the secondary repair (27654)is that the provider is repairing it a 2nd time. With this new information I was thinking that I should use the 27652 and that the FHL tendon graft is included. My doc is coding it as 27654 and 27691?? Any clarification is appreciated.


  • edited May 2017
    There are different definitions for secondary repair - and a secondary
    repair code could be used even though the tendon has never been fixed before.
    July 2014 CPT Assistant:
    "In the May 2011, CPT Assistant (page 9), a Q&A incorrectly states that
    code 28200, Repair, tendon, flexor, foot; primary or secondary, without
    free graft, each tendon, should be reported for the repair of the Achilles
    tendon. Instead, the following specific Achilles tendon repair codes should
    be used as appropriate for these repairs: 27650, Repair, primary, open or
    percutaneous, ruptured Achilles tendon; 27652, Repair, primary, open or
    percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft);
    and 27654, Repair, secondary, Achilles tendon, with or without graft. In
    addition, it would be appropriate to report code 27654 for the debulking of a
    thickened Achilles tendon or excision of intratendinous calcifications."

    March 2014 CPT Assistant:
    "Question: Is code 27698, Repair, secondary, disrupted ligament, ankle,
    collateral (eg, Watson-Jones procedure), the appropriate code to report when
    a Brostrom-Gould procedure is performed? The calcaneofibular ligament
    (CFL) and anterior talofibular ligament (ATFL) are taken off the fibula and
    then reefed back down, with the extensor retinaculum incorporated with the
    ligaments, securing them with anchors into the fibula. It may be the primary
    repair done sometime after the index injury or onset of condition.
    Answer: The terms “primary” and “secondary” in the code descriptors
    denote that code 27695, Repair, primary, disrupted ligament, ankle; collateral,
    is reported for an acute injury repair, and code 27698, Repair, secondary,
    disrupted ligament, ankle; collateral (eg, Watson-Jones procedure), is
    reported for a chronic injury repair. If the surgeon performs a primary
    repair, it does not matter when the repair was done; either code 27695, Repair,
    primary, disrupted ligament, ankle; collateral, or code 27696, Repair,
    primary, disrupted ligament, ankle; both collateral ligaments, may be reported
    depending upon the extent of the repair. If the surgeon performs a
    secondary repair, the repair is a reconstruction (code 27698), regardless of when
    it was done in relation to the time of the initial injury. A primary repair
    refers to joining two ends of the ligaments together, whereas a secondary
    repair requires other tissue to be used to do the repair because a primary
    repair is no longer possible. Therefore, in response to your specific
    question, if a secondary repair is performed, code 27698 may be reported for the
    Brostrom-Gould procedure.

    Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
    Auditing, Coding, Documentation and Compliance Consulting
    Healthcare Consultant
    _scalley123@aol.com_ (
    cell 360-880-8304
    fax 413-674-7668
    _www.margievaught.com_ (
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