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. 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.
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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