L>sdrta.net On-Line company December 2003 BulletinDecember 2003 Bulletin

Accurately code foot and also ankle procedures

Learn instructions and also examples

By Margie Scalley Vaught, CPC, CCS-P, MCS-P and reviewed through Walter J. Pedowitz, MD

sdrta.net members have actually requested ~ above a variety of occasions that the Bulletin sheathe foot steps that can be lacking a correlation come CPT codes. In this issue, we respond to those requests and also will comment on several procedures and corresponding CPT codes. Lisfranc fracture/dislocation This form of injury deserve to be continual with a fracture add by dislocation the the tarsometatarsal (Lisfranc) joint situated in the middle of the foot. This injury have the right to be resulted in by a high-energy blow to the foot or through a twisting fall. (Lisfranc to be a operated doctor in Napoleon’s army; thus, the name is based upon his description of the injury endured by a soldier who dropped off a equine with his foot trapped in the stirrup.) The system of the injury causes the tarsal bones to dislocate through or there is no resulting metatarsal (MT) fractures. Plenty of times, both the dislocation and also the fracture space treated independently with stabilization devices, which deserve to be closed, percutaneous or open. Individually coding because that the continuous of the metatarsal fractures could depend on the place of those fractures. Lisfranc dislocation have the right to be because that one or plenty of of the tarsometatarsal joints. The open up reduction code is because that each joint the is decreased in an open up fashion. Here are part examples:

Tarsometatarsal dislocation that the appropriate midfoot in addition to mid-shaft fractures of the 2nd, third and fourth MTs: The dislocation is treated by open reduction interior fixation (ORIF). The MT fractures are additionally treated through ORIF by separate incisions. CPT password 28615 would certainly be reported because that the continuous of the dislocation. CPT password 28485-59 would certainly be reported three times to represent each metatarsal fracture, every CPT summary of the code. Comprehensive T, per CPT, would not be appropriate for this metatarsal column fractures. Percutaneous permanent of left tarsometatarsal dislocation with linked fracture in ~ the basic of the second left metatarsal (it can be any type of one of 5 metatarsals) the is likewise stabilized through the percutaneous fixation of the dislocation: CPT password 28606 would certainly be reported, every joint. Due to the fact that the fracture is also fixed by the dislocation fixation, separate reporting may not be indicated.

Pump bump Whether referred to as “pump bump” (for association of shoes pumps causing irritation ~ above the back of the heel), Haglund, bone spur or exostosis that the calcaneous, is typically the very same CPT code 28118. Excision of a bone spur v the Achilles tendon can additionally be reported making use of 28118 due to the fact that the attaching or reattaching of the Achilles tendon to obtain to this spur would be thought about inherent in the removed of the spur. CPT password 28118 represents, “Ostectomy, calcaneus.” now CPT code 28119 represents, “Ostectomy, calcaneus; because that spur, with or there is no plantar fascial release,” which would certainly be reported once there is a spur on the bottom that the foot and a plantar fascial relax may also be performed.

cut exostosis vs. Partial excision—codes 28100-28108 vs. 28120-28124 Both set of codes refer to excision that bone but that is wherein the similarities end. Password 28100-28108 describe excision that bone cysts or bright tumor of the talus, calcaneous, tarsal, metatarsal or phalanges. To report these codes, there must be supporting information of an actual cyst or tumor. codes 28120-28124 describe partial cut of bone the the talus, calcaneous, tarsal, metatarsal or phalanges. This codes explain some specific types of excisions such as craterization or saucerization (excavation of tissue to kind a shallow depression, performed in wound therapy to facilitate drainage native infected areas), sequestrectomy (a piece of necrotic bone that is operation removed) or diaphysectomy (partial or finish removal of the column of a lengthy bone). Lock may likewise be provided for some medical problems such as osteomyelitis or bossing, yet remember that CPT claims that “eg” is not all-inclusive. Below are some examples: cut of 4th phalange exostosis – 28124 cut of solitary bone cyst in the calcaneous – 28100

Hammertoes Hammertoe corrections room reported through CPT code 28285. The sdrta.net finish Guide to an international Service Data, (2003 edition) states the complying with procedures would certainly be considered/included in the report of 28285:

Arthrotomy (eg 28022) Extensor tenotomy and repair (eg 28208, 28234) Capsulotomy because that joint contracture (eg 28272) Synovial biopsy (eg 28054) interior fixation (eg 28675) Implant insertion excision of exostosis (eg 28124) cut of skin lesion (eg 11420-11426) Hemiphalangectomy (eg 28126, 28160) neighborhood bone graft Phalangectomy (eg 28150)

As shown above, the inner fixation is included in the procedure. This refers to K-wires or other gadgets that are offered to stabilize the toe. Remember the the remove of the K-wires throughout the postoperative period would typically be considered inherent in their placement and thus extr coding would not take place. Even though the K-wires are hidden just under the skin and also a tiny incision is made to eliminate them, castle are hidden for patience comfort and protection. What is not included in the hammertoe correction is 28270— capsulotomy the the metarsalphalangeal (MTP) joint as this is in a various joint location. Posterior malleolar fractures The referral to posterior malleolar fractures has actually caused part coders concern since there is no a particular CPT code that states posterior malleolus. There room codes because that lateral, medial, bimalleolar and trimalleolar yet none that specifically claims posterior. The distal tibia has a big flat articular surface (the plafond), a influential medial malleolus and also a less prominent posterior malleolus. Permanent of the posterior malleolus is typically performed when more than 30 percent the the joint surface ar is involved. Many times these injuries are also associated with other malleolar fractures. There are CPT codes that deal with the distal tibial plafond: 27824 Closed treatment of fracture that weight-bearing articular part of distal tibia (eg, pilon or tibial plafond), v or there is no anesthesia; without manipulation 27825 Closed therapy of fracture the weight-bearing articular portion of distal tibia (eg, pilon or tibial plafond), v or without anesthesia; v skeletal traction and/or request manipulation 27826 open up treatment of fracture of weight-bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal or exterior fixation; the fibula just 27827 open treatment that fracture of weight-bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal or external fixation; the tibia only Cheilectomy CPT password 28289 represents “Hallux rigidus correction with cheilectomy, debridement and capsular release of the an initial metatarsophalangeal share (MTP).” countless have take away this to typical that this CPT code can not be supplied if the cheilectomy was performed for degenerative arthritis that the an initial MTP joint. In fact, you will discover that many CPT and also ICD-9 linkage software will show that the only diagnoses that have the right to be reported v this procedure is that of hallux rigidus. Hallux rigidus is synonymous with arthritis, but many workplaces have continued to default to report the one ICD-9 password 735.2 hallux rigidus—when in actuality, report the proper arthritis ICD-9 code have to be offered when the clinical record reflects this. The actual cheilectomy surgical procedure is that of removed a bump or spur top top the optimal of the key joint of the huge toe. Since bone spurs deserve to be resulted in by arthritis, this CPT password represents that surgical procedure. understanding the CPT language the a offered CPT procedure code deserve to be an overwhelming at times due to the fact that surgeons don’t always speak, “CPTism.” Thus, ideal code an option can become a problem. as soon as it involves coding and reporting foot and also ankle procedures, coders and surgeons must work together a team to entrust the ideal CPT and also ICD-9 codes based on supporting documentation. Orthopaedic surgeons have to be mindful of the code descriptions and also supply the suitable wording to support the selection. CPT and ICD-9 indict both state that if share or unsure descriptions room provided, coders room to go earlier to the doctor for additional clarification. Documentation is the vital element in compliance, and in coding and also reimbursement. Working as a team can alleviate extra coding steps, if documentation is plainly cited.

References CPT 2003 skilled Edition, American clinical Association ICD-9-CM Coding hands-on 2003 sdrta.net complete Guide to global Service Data, 2003 version Margie S. Vaught, CPC, CCS-P, MCS-P, is an independent coding professional in Ellensburg, Wash.

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She is likewise a member that the American Academy of experienced Coders’ nationwide Advisory Board. She can be got to at vaught