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Surgery Center Coding Guidance: Haglund's Deformity

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Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.

Haglund's Deformity

A Haglund's deformity can be referred to by a number of different names such as bony enlargement, prominent bump, pump bump, or retrocalcaneal exostosis.  Just as confusing is how an excision of the Haglund's deformity should be reported with the American Hospital Association (AHA Coding Clinic for HCPCS) and the American Medical Association (AMA CPT Knowledge Base) have varying opinions.   In a majority of the surgical procedures performed, access to the deformity is made through the Achilles tendon and then the Achilles is subsequently repaired.  With that in mind let's look at the differing opinions.

AHA Coding Clinic for HCPCS
This patient presents with Achilles tendonitis and a Haglund's deformity.  A large retrocalcaneal bursa is found and excised along with a large prominence at the posterior aspect of the calcaneus.  Based on the information that was presented to AHA Coding Clinic, they recommended CPT code 27654 (secondary repair of the Achilles tendon without graft) stating that "all components of this procedural process would be captured under 27654 including the removal of the calcaneal spur with the tendon so no additional code would be reported for this procedure."

AMA CPT Knowledge Base
This patient was diagnosed with retrocalcaneal bursitis and Haglund's deformity.  Retrocalcaneal bursa is excised and an osteotome is used to remove the Haglund's deformity.  Debridement of necrotic area of the Achilles tendon is performed and the incision is closed in layers.  Based on the information that was presented to AMA Knowledge Base, they recommended CPT code 28118 (ostectomy, calcaneus) and additionally stating "if work, other than for exposure was performed on the Achilles tendon then that service should be reported as 28200 – secondary repair of tendon, foot, without graft)."

So as you can see there is a major difference in the coding recommendations made by each of these Associations.  As far as opinions and recommendations go – In my opinion, the information from AMA CPT Knowledge Base best represents the services that were performed and since I have to make a decision as to how the service should be reported my recommendation would be to use this information for coding purposes.

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

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