# Lisfranc Dislocation



## coderguy1939 (Apr 1, 2009)

Doctor did an open repair of a tarsometatarsal dislocation (Lisfranc dislocation) and he place hardware in the first and second metatarsals.  The second metatarsal was pinned into the cuneiform bone and the first metatarsal was pinned into the base of the second metatarsal.  I'm looking at 28615--can this be coded twice. 

Thanks for your input.


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## mbort (Apr 7, 2009)

David, 

Yes, you you have more than one tarsometatarsal fracture/dislocation, then you would code it per fracture/dislocation.  If all five are fractured/dislocated, then you code all five.

Mary, CPC,COSC


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## coderguy1939 (Apr 7, 2009)

Mary,

In the op report, the doctor has a diagnosis lisfranc fracture and dislocation, but in the body of the op report he never describes the fractures only the dislocation/subluxation of all four metatarsals.  He only pins the first two metatarsals.  This seems to me to be dislocation only.  So I can code 28615 twice with a modifier 59.


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## sdomel159 (Apr 8, 2009)

Goodmorning--there is a good article in Orthopedic Coding alert from April 2006and also the AAOS bulletin from December 2003--that addresses this issue.  My thought is that since he pinned the 1st MT to the 2nd MT and not to a tarsal bone would you instead (if the MT's were fractured) code 28485?  28615 is fixing the joint(s) between the tarsal and the metatarsal--so without seeing the whole op note sounds like he fixed one tarsometatarsal joint and fixed the 1st MT to the 2nd.  I would be hesitant to code 28615 twice. If you need copies of these articles please let me know-I will fax them to you.


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