Query: Not Paid For Tendo-Achilles Lengthening.
I am having a difficult time getting paid on a
tendo-Achilles lengthening procedure (CPT 27685 -
lengthening or shortening of tendon, leg or
ankle; single tendon [separate procedure]). The
insurance company is calling it "an incidental
procedure."
I did get paid for reconstruction (advancement),
posterior tibial tendon with excision of
accessory tarsal navicular bone (e.g., Kidner-
type procedure) - CPT 28238; and on arthrodesis,
midtarsal or tarsometatarsal, single joint - CPT
28740, but I can't seem to get paid on the tendo-
Achilles lengthening procedure.
Do you have any suggestions?
Allan S. Wax, DPM
Chester, VA
Several things come to mind. Make sure one of
the existing specific tendo-Achilles lengthening
codes did not define the lengthening procedure
you performed:
1) CPT 27605 (tenotomy, percutaneous, Achilles
tendon [separate
procedure]; local anesthesia); or
2) CPT 27606 (tenotomy, percutaneous, Achilles
tendon [separate
procedure]; general anesthesia); or
3) CPT 27687 (gastrocnemius recession)
If you performed one of these procedures, send
in a corrected claim with the appropriate
procedure code, op report, and letter of
explanation. You should append a “-59” modifier
to the procedure code.
If, however, you performed an “open” tendo-
Achilles lengthening (CPT 27685) – as you
originally billed - then the payer is not
differentiating the tendon lengthening
(advancement) included in the Kidner procedure
with the tendo-Achilles lengthening either
because you didn’t appending a “-59” modifier
(distinct procedure service) to the generic
leg/ankle tendon lengthening procedure you
billed, and the payer bundled the lengthening
into CPT 28238; or the payer is mistakenly
denying your independent TAL. In the former
case, send in a corrected claim appending a “-
59” modifier to CPT 27685, and a letter of
explanation noting the independent nature of the
procedure – different problem, different site of
surgery. In the latter case, send in an appeal
letter, explaining, in detail, the distinctions
of the procedures performed (existing
deformities; procedures performed; relationship
of the procedures to deformities to sites of
surgery to codes, etc.). You should also note
that none of the standard global bundling
references (Correct Coding Initiative, AAOS
Complete Global Service Data, and APMA Task
Force on Global Surgical Services Intra-
operative Services Report) bundle CPT 28238 (or
CPT 28740) and CPT 27685.
This is one to fight for.
Harry Goldsmith, DPM
Cerritos, CA
