# Which codes - 28615, 28485 or another?



## jdibble (May 7, 2015)

I am new to ortho coding and am not sure exactly what was done here - if anyone can help that would be great!! Also if someone could explain the difference between fracture and dislocation as it seems this doctor uses these terms interchangably!!

PREOPERATIVE DIAGNOSIS:  Left foot Lisfranc fracture dislocation.

POSTOPERATIVE DIAGNOSIS:  Left foot Lisfranc fracture dislocation.

OPERATION:  Open reduction, internal fixation of the Lisfranc fracture
dislocation, homolateral type.

SURGEON:  

ANESTHESIA:  General endotracheal.

DESCRIPTION OF PROCEDURE:  The patient was brought to the operative theater, placed supine upon the operating room table, and after satisfactory general endotracheal anesthesia was administered, a tourniquet was applied to the left upper thigh and left lower extremity prepped and draped in the usual meticulous sterile fashion from the knee, to and including the foot. C arm fluoroscopy will be utilized throughout the case for visualization of the fracture reduction.  A time-out was carried confirming the operating site with the operative consent.  The foot was elevated an extremity exsanguinated, and tourniquet was inflated up to 300 mm of mercury.  The foot was visualized in both AP and lateral planes with the C-arm fluoroscopy.  A closed reduction was carried out initially reducing the first tarsal metatarsal joint.  An incision was then made over the dorsum of the tarsal metatarsal joint allowing for retraction of the extensor hallucis tendon.  A guide pin was then passed through the base of the first metatarsal into the medial cuneiform maintaining its position.  The second metatarsal was reduced by open reduction by making an incision over the base of the second metatarsal dissecting into the base of the second metatarsal where the ligamentous disruption had occurred between the first cuneiform and the second metatarsal.  A tenacula clamp was then utilized to reduce the base of the second metatarsal and medial cuneiform to the first cuneiform.  This was visualized in near anatomic position in both AP and lateral planes.  A guide pin was passed through the medial cuneiform into the base of the second metatarsal, extra-articularly.  Position was maintained and visualized in both AP and lateral planes with the C-arm.  A 4.0 self-tapping cannulated screw was placed after appropriate measurement of the guide wire had been carried out.  This was passed through the medial cuneiform, such that I would capture the base of the second metatarsal and maintained its reduction. This did so, and in fact, allow for some continued reduction by lagging.  The first and second cuneiforms were reduced and held with a transverse screw through the medial cuneiform into the second cuneiform with a lag screw.  The first tarsal metatarsal joint having been maintained in reduction with the guide wire, allowed for a third 4.0 cancellous lag screw being passed through the base of the first metatarsal into the medial cuneiform, maintaining its reduction in anatomic position.  At this point, the third and fourth tarsal metatarsal joint have been reduced and the fifth tarsal metatarsal joint was reduced as well.  At this point, it was elected to maintain the reduction of the lateral digits and this was carried out by utilizing a 4.0 cancellous lag screw to the base of the fifth metatarsal across the tarsal metatarsal joint, maintaining an anatomic position.  This was verified in both AP and lateral planes with C-arm and was taken through a small stab wound with blunt dissection down to the bone for placement of the screw.  The wounds were then copiously irrigated and deep tissues closed with #2-0 Vicryl, skin reapproximated with skin staples.  Near anatomic reduction had been carried out throughout the foot and it was placed in a Cadillac splint over the wounds that were dressed with Xeroform, 4 x 4's and abulky foot dressing placed. The tourniquet was released, and the patient tolerated the procedure well and was returned to recovery.

Thanks for any help on this!!


----------



## jjhamer1 (May 7, 2015)

*Lisfranc fracture dislocation*

Dislocation and fracture of same anatomical sight is common.

Dx - 825.29 - Fracture of tarsal/metatarsal bone, closed

28485-LT - Open treatment of metatarsal fracture, includes internal fixation, when performed

28465-LT X 4
Open treatment of tarsal bone fracture, includes internal fixation when performed, each


----------



## jdibble (May 8, 2015)

Thank you jjhamer! But now if you could just tell me why I would use the 28465 over the 28615? What in the note would direct me to one code over the other? Just wondering because the doctor picked the 28615 and I have to go back to him and show him the correct code and the reason why!

Thanks again for all help!


----------



## jjhamer1 (May 8, 2015)

*Lisfranc fracture dislocation*

According to documentation this is: Lisfranc fracture dislocation
OPERATION: Open reduction, internal fixation of the Lisfranc fracture
dislocation, homolateral type.

 28465 - Open treatment of tarsal bone fracture, includes internal fixation, when performed, each (fracture)

28615 - Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed. (dislocation)


----------



## solocoder (May 8, 2015)

I don't see any fractured bones mentioned. Only dislocated joints. And it sounds like all 5 tarsometatarsal joints.
28615 x 5?


----------



## jjhamer1 (May 11, 2015)

*Lisfranc fracture dislocation*

Fourth line of the operative note states:

C arm fluoroscopy will be utilized throughout the case for visualization of the fracture reduction.


----------



## BenCrocker (May 11, 2015)

Can fractures be dislocated?


----------



## jjhamer1 (May 12, 2015)

*Can fractures be dislocated?*

Definitely!


----------

