Coding Guidance-Primary vs Secondary collateral ankle ligament repair

Coding Guidance-Primary vs Secondary collateral ankle ligament repair.

Ask a coder what the difference is between a primary and secondary ankle ligament repair and many will refer you back to the Coder's Desk Reference which indicates a secondary repair occurs a period of time after the initial injury and for the most part, this is true. However, based on information received from the AMA, code selection does not take into consideration the timing of the injury, but rather, how the ligaments were repaired. With a primary repair the ends of the ligaments are brought back together and then sutured to each other. 27695 — Repair, primary, disrupted ligament, ankle, collateral — is reported for this type of repair when it is associated with an acute injury of the ATFL (anterior talofibular ligament) or CFL (calcaneofibular ligament). If both the ATFL and CFL are repaired in an end-to-end fashion then 27696 — both collateral ligaments — would be reported.

Secondary means other tissue is brought in to perform the repair because it's too late to do a primary repair (usually a period of time after the injury). Procedures like Evans, Watson-Jones and Chrisman-Snook are all considered secondary repairs because a proximal portion of the peroneus brevis is released and then passed through drill hole(s) in the fibula and navicular or calcaneal bones to reconstruct the ATFL and/or the CFL. With these types of procedures there is no repair made to the ligament itself.

A physician may perform a direct repair to the ligament(s) (primary) and supplement or reinforce that repair by transferring the extensor retinaculum up over the ligament(s) in what's called a Gould modification(Broström). The AAOS (American Academy of Orthopaedic Surgeons) includes "transfer or mobilization of the adjacent retinaculum" in a primary repair so this should not be additionally reported. Don't confuse the Gould modification with a secondary repair.

In general, when the physician performs a direct repair to the ankle collateral ligaments this would be considered a primary repair regardless of when the injury occurred.