Epiphysiodesis is the reversible surgical fusion of the epiphyseal plate to forestall growth in a child who has

one leg that is longer than the other and needs to wait until the other leg grows to the same length.

27650 Repair, primary, open or percutaneous, ruptured Achilles tendon;

27652 with graft (includes obtaining graft)

27654 Repair, secondary, Achilles tendon, with or without graft 27656 Repair, fascial defect of leg

27658 Repair, flexor tendon, leg; primary, without graft, each tendon

27659 secondary, with or without graft, each tendon 27664 Repair, extensor tendon, leg; primary, without graft, each

tendon

27665 secondary, with or without graft, each tendon 27675 Repair, dislocating peroneal tendons; without fibular

osteotomy

27676 with fibular osteotomy

27680 Tenolysis, flexor or extensor tendon, leg and/or ankle;

single, each tendon

27681 multiple tendons (through separate incision[s]) 27685 Lengthening or shortening of tendon, leg or ankle; single

tendon (separate procedure)

27686 multiple tendons (through same incision), each

27687 Gastrocnemius recession (eg, Strayer procedure) 27690 Transfer or transplant of single tendon (with muscle

redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)

27691 deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)

✚27692 each additional tendon (List separately in addition to code for primary procedure)

27695 Repair, primary, disrupted ligament, ankle; collateral 27696 both collateral ligaments

27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure)

27700 Arthroplasty, ankle;

27702 with implant (total ankle) 27703 revision, total ankle 27704 Removal of ankle implant 27705 Osteotomy; tibia

27707 fibula

27709 tibia and fibula

27712 multiple, with realignment on intramedullary rod (eg, Sofield type procedure)

27715 Osteoplasty, tibia and fibula, lengthening or shortening 27720 Repair of nonunion or malunion, tibia; without graft, (eg,

compression technique) 27722 with sliding graft

27724 with iliac or other autograft (includes obtaining graft) 27725 by synostosis, with fibula, any method

27726 Repair of fibula nonunion and/or malunion with internal fixation

27727 Repair of congenital pseudarthrosis, tibia

27730 Arrest, epiphyseal (epiphysiodesis), open; distal tibia 27732 distal fibula

27734 distal tibia and fibula

27740 Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula;

27742 and distal femur

27745 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

27635—27745

FIGURE 2-46. Muscles of the Leg

Like the hands, the feet are animated by tendons attached to muscles of the adjacent limb (extrinsic);

they do not rely on their own intrinsic muscle groups. In the anterior lower leg, the tibialis anterior, extensor digitorum longus, and extensor halluces longus provide dorsal extension to the ankle joint and toes. The calf muscles of the lower leg, ie, gastrocnemius and soleus, merge into the Achilles tendon at the base of the calf muscle. The Achilles tendon inserts into the calcaneus.

Vastus lateralis muscle

Iliotibial tract Superior lateral genicular artery Lateral patellar retinaculum

Biceps femoris tendon Inferior lateral genicular artery Common fibular (peroneal) nerve

Head of fibula

Fibularis (peroneus) longus muscle

Tibialis anterior muscle

Fibula Superior extensor retinaculum Lateral malleolus Inferior extensor retinaculum Extensor digitorum longus tendons Fibularis (peroneus) tertius tendon Extensor digitorum brevis tendons

Dorsal digital nerves

Vastus medialis muscle Patella

Superior medial genicular artery Tibial collateral ligament Medial patellar retinaculum Inferior medial genicular artery Infrapatellar branch (cut) of Saphenous nerve (cut) Joint capsule Patellar ligament

Insertion of sartorius muscle Tibial tuberosity

Tibia

Gastrocnemius muscle

Soleus muscle

Medial malleolus Rectus femoris tendon (becoming

quadriceps femoris tendon)

Superficial fibular (peroneal) nerve (cut)

Fibularis (peroneus) brevis muscle

Extensor digitorum longus muscle

Dorsal digital branches of deep fibular (peroneal) nerve Extensor hallucis brevis tendon Extensor hallucis longus tendon

Medial branch of deep fibular (peroneal) nerve Tibialis anterior tendon

Extensor hallucis longus muscle

Superficial Dissection: Anterior View Lateral View

Vastus lateralis muscle

Lateral patellar retinaculum Superior lateral genicular artery Quadriceps femoris tendon Iliotibial tract

Patella

Tibialis anterior muscle Tibial tuberosity Patellar ligament Lateral condyle of tibia

Superior extensor retinaculum Inferior extensor retinaculum

5th metatarsal bone

Fibularis (peroneus) tertius tendon Fibularis (peroneus) brevis tendon Extensor digitorum longus tendons Extensor hallucis longus tendon Extensor digitorum brevis muscle Extensor hallucis longus muscle and tendon Extensor digitorum longus tendon

Superficial fibular (peroneal) nerve (cut)

Extensor digitorum longus muscle

Lateral malleolus Calcaneal (Achilles) tendon (Subtendinous) bursa of tendocalcaneus Superior fibular (peroneal) retinaculum Inferior fibular (peroneal) retinaculum Fibularis (peroneus) longus tendon passing to sole of foot

Fibula Soleus muscle

Fibularis (peroneus) longus muscle and tendon

Fibularis (peroneus) brevis muscle and tendon

Fibular collateral ligament

Common fibular (peroneal) nerve

Inferior lateral genicular artery

Head of fibula

Gastrocnemius muscle Long head Short head Tendon Biceps

femoris muscle

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Vastus lateralis muscle

Iliotibial tract Superior lateral genicular artery Lateral patellar retinaculum

Biceps femoris tendon Inferior lateral genicular artery Common fibular (peroneal) nerve

Head of fibula

Fibularis (peroneus) longus muscle

Tibialis anterior muscle

Fibula Superior extensor retinaculum Lateral malleolus Inferior extensor retinaculum Extensor digitorum longus tendons Fibularis (peroneus) tertius tendon

Extensor digitorum brevis tendons

Dorsal digital nerves

Vastus medialis muscle Patella

Insertion of sartorius muscle Tibial tuberosity

Tibia

Gastrocnemius muscle

Soleus muscle

Medial malleolus Rectus femoris tendon (becoming

quadriceps femoris tendon)

Superficial fibular (peroneal) nerve (cut)

Fibularis (peroneus) brevis muscle

Extensor digitorum longus muscle

Dorsal digital branches of deep fibular (peroneal) nerve Extensor hallucis brevis tendon Extensor hallucis longus tendon

Medial branch of deep fibular (peroneal) nerve Tibialis anterior tendon

Extensor hallucis longus muscle

Superficial Dissection: Anterior View Lateral View

Vastus lateralis muscle

Lateral patellar retinaculum Superior lateral genicular artery Quadriceps femoris tendon Iliotibial tract

Patella

Tibialis anterior muscle Tibial tuberosity Patellar ligament Lateral condyle of tibia

Superior extensor retinaculum Inferior extensor retinaculum

5th metatarsal bone

Superficial fibular (peroneal) nerve (cut)

Extensor digitorum longus muscle

Fibula Soleus muscle

Fibularis (peroneus) longus muscle and tendon

Fibularis (peroneus) brevis muscle and tendon

Fibular collateral ligament

Common fibular (peroneal) nerve

Inferior lateral genicular artery

Head of fibula

Gastrocnemius muscle Long head Short head Tendon Biceps

femoris muscle

FIGURE 2-46. Muscles of the Leg (continued)

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

Anterior intercondylar area

Lateral

condyle Lateral

condyle Apex,

head, neck of fibula

Apex, head, neck of fibula

Lateral surface

Lateral malleolus

Inferior articular surface

Fossa of lateral malleolus Lateral surface

Posterior border Posterior

surface Nutrient foramen Soleal line Lateral

intercondylar tubercle

Lateral intercondylar tubercle Superior

articular surface Intercondylar eminence Intercondylar eminence

Medial intercondylar tubercle

Medial intercondylar tubercle Posterior intercondylar area

Medial condyle

Tuberosity Groove for semimembranosus tendon

Lateral surface

Malleolar articular surface

Malleolar articular surface Medial

malleolus Medial malleolus

Lateral malleolus Fibular notch Groove for

tibialis posterior and flexor digitorum longus tendons Anterior

border

Anterior border Interosseous

border Interosseous

border

Interosseous border

Medial surface

Medial

surface Medial

border

Posterior surface Medial crest Oblique

line for iliotibial tract

Posterior view Anterior view

Fibula

Fibula Tibia Tibia

FIGURE 2-47. Tibia and Fibula

The fibula connects to the tibia by means of an articulation and with ligaments. Only the tibia articulates in the knee joint itself, though both bones articulate at the talus to form the ankle joint.

The tibia carries body weight, while the smaller, thinner fibula does not. The anterior tibia lies close to the skin surface and is referred to as the shin bone.

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Fracture and/or Dislocation

Coding Atlas

The tibia is the most commonly fractured long bone.

Sports and motor vehicle accidents account for many of these fractures. Because the skin over the anterior and medial tibia is thin, tibial fractures are often open fractures. Fibula fractures usually occur in conjunction with tibia fractures.

27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation

27752 with manipulation, with or without skeletal traction 27756 Percutaneous skeletal fixation of tibial shaft fracture

(with or without fibular fracture) (eg, pins or screws) 27758 Open treatment of tibial shaft fracture (with or without

fibular fracture), with plate/screws, with or without cerclage

27759 Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage

27760 Closed treatment of medial malleolus fracture; without manipulation

27762 with manipulation, with or without skin or skeletal traction

27766 Open treatment of medial malleolus fracture, includes internal fixation, when performed

27767 Closed treatment of posterior malleolus fracture; without manipulation

27768 with manipulation

27769 Open treatment of posterior malleolus fracture, includes internal fixation, when performed

27780 Closed treatment of proximal fibula or shaft fracture;

without manipulation 27781 with manipulation

27784 Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed 27786 Closed treatment of distal fibular fracture (lateral

malleolus); without manipulation 27788 with manipulation

27792 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed 27808 Closed treatment of bimalleolar ankle fracture (eg, lateral

and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation 27810 with manipulation

27814 Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed

27816 Closed treatment of trimalleolar ankle fracture; without manipulation

27818 with manipulation

27822 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip

27823 with fixation of posterior lip

27824 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation

27825 with skeletal traction and/or requiring manipulation 27826 Open treatment of fracture of weight bearing articular

surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only 27827 of tibia only

27828 of both tibia and fibula

27829 Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed 27830 Closed treatment of proximal tibiofibular joint

dislocation; without anesthesia 27831 requiring anesthesia

27832 Open treatment of proximal tibiofibular joint dislocation, includes internal fixation, when performed, or with excision of proximal fibula

27840 Closed treatment of ankle dislocation; without anesthesia

27842 requiring anesthesia, with or without percutaneous skeletal fixation

27846 Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation

27848 with repair or internal or external fixation

Manipulation

27860 Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

27750—27860

Posterior talofibular ligament Calcaneofibular ligament

Anterior talofibular ligament

Components of lateral (collateral) ligament of ankle

Interosseous talocalcaneal ligament Dorsal talonavicular ligament

Calcaneonavicular ligament

Calcaneocuboid ligament Bifurcate ligament Dorsal cuboideonavicular ligament

Dorsal cuneonavicular ligaments Dorsal intercuneiform ligaments

Dorsal tarsometatarsal ligaments

Dorsal metatarsal ligaments Dorsal cuneocuboid ligament Cuboid bone

Dorsal calcaneocuboid ligament

Tibia

Medial talocalcaneal ligament Posterior process of talus

Posterior talocalcaneal ligament

Calcaneal (Achilles) tendon (cut)

Sustentaculum tali

Long plantar ligament Short plantar

ligament Plantar calcaneo - navicular (spring) ligament Tibialis posterior tendon

Tibialis anterior tendon Tuberosity

1st metatarsal bone

Dorsal tarsometatarsal ligaments Dorsal intercuneiform ligament

Medial cuneiform bone Dorsal cuneonavicular ligaments

Navicular bone Dorsal talonavicular ligament

Posterior tibiotalar part Tibiocalcaneal part Tibionavicular part Anterior tibiotalar part Medial (deltoid)

ligament of ankle

Right foot: Medial view Fibularis (peroneus) brevis tendon

Fibularis (peroneus) longus tendon Long plantar ligament Lateral talocalcaneal ligament Inferior

fibular (peroneal) retinaculum Calcaneal (Achilles) tendon (cut)

Anterior and Posterior tibiofibular ligaments Superior fibular (peroneal) retinaculum

Fibula

Tibia Right foot: Lateral view

FIGURE 2-48. Ligaments and Tendons of the Ankle and Foot

Tendons emerge from muscle to connect to bone. When the muscle contracts, the tendon pulls the bone and causes it to move. Muscle action is affected when a tendon is injured. Ligaments provide stability by connecting bone to bone. An ankle sprain occurs when ligaments are torn or stretched. In the ankle, the lateral ligaments are the most common sites of a sprain, as the outer ankle turns under, injuring the anterior talofibular ligament (ATFL) and/or calcaneofibular ligament (CFL).

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Arthrodesis

Coding Atlas

In arthrodesis, the joint is surgically fused and

immobilized. Bone grafts may be placed to fix the joint;

otherwise, hardware is placed. Code selection is based on the joint(s) treated.

27870 Arthrodesis, ankle, open

27871 Arthrodesis, tibiofibular joint, proximal or distal

Amputation

Coding Atlas

A guillotine amputation creates a flat wound across the limb. It does not provide skin for adequate closure.

Guillotine amputation is typically performed in emergent situations and is followed by wound monitoring for disease prior to a second surgery for revision and flap.

27880 Amputation, leg, through tibia and fibula;

27881 with immediate fitting technique including application of first cast

27882 open, circular (guillotine) 27884 secondary closure or scar revision 27886 re-amputation

27888 Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves

27889 Ankle disarticulation

Other Procedures

Coding Atlas

If compartment syndrome (CS) is not treated, blood flow to muscle tissue is compromised and necrosis results.

These codes are used to report decompression fasciotomy with debridement of necrotic or otherwise nonviable tissues within the compartment.

27892 Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve

27893 posterior compartment(s) only, with debridement of nonviable muscle and/or nerve

27894 anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve

Dalam dokumen Netter's Atlas of Surgical Anatomy for CPT® Coding (Halaman 126-132)