Ask Dr. Z

"Periosteal elevator was used to dissect the femur to a position higher than the soft tissue amputation. This level was at the upper third of the femur. We then used the pneumatic saw to divide the femur. We then trimmed the anterior aspect of the femur so that it was beveled and had a smooth edge. We then divided the posterior flap of soft tissue. As he has become more cachectic, the soft tissue around his prior left above-knee amputation has atrophied. In addition to this problem, he has developed hyperostosis of the distal aspect of his femur. This has caused severe ulceration with exposed bone of the distal aspect of the left above-knee amputation site." The provider used code 27590, and the coder used 27596... can you tell us when it is appropriate to report code 27596? This was done two years after original amputation.