# Coding For Lis Franc Fracture??



## aprilroc (Feb 4, 2009)

Code 28615 does not clearly state in code book if this could be used multiple times for each dislocation/fracture. The surgeon did ORIF of first, second, fourth and fifth metatarsals with multiple pinning and wants to charge this code X 4. Does anybody have any knowledge if this is correct coding? Thanks:


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## mitchellde (Feb 4, 2009)

This code is for each joint so it can be billed multiple times as 4 line items with the appropriate T modifers depending on which foot, if it is the left foot the TA, T1, T3, T4, right foot would be T5, T6,T8, T9
Debra Mitchell, MSPH, CPC-H


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## hdavis34 (Nov 20, 2013)

I wanted to put this in for future reference when I look this up again, just in case, I found this through Margie Scully-Vaught.

Lisfranc fracture/dislocation
 This type of injury can be consistent with a fracture accompanied by dislocation of the tarsometatarsal (Lisfranc) joint located in the middle of the foot. This injury can be caused by a high-energy blow to the foot or by a twisting fall. (Lisfranc was a surgeon in Napoleon's army; thus, the name is based on his description of the injury suffered by a soldier who fell off a horse with his foot trapped in the stirrup.) 

 The mechanism of the injury causes the tarsal bones to dislocate with or without resulting metatarsal (MT) fractures. Many times, both the dislocation and the fracture are treated separately with stabilization devices, which can be closed, percutaneous or open. Separately coding for the fixation of the metatarsal fractures could depend on the location of those fractures. Lisfranc dislocation can be for one or many of the tarsometatarsal joints. The open reduction code is for each joint that is reduced in an open fashion. Here are some examples:

•Tarsometatarsal dislocation of the right midfoot along with mid-shaft fractures of the 2nd, 3rd and 4th MTs: The dislocation is treated by open reduction internal fixation (ORIF). The MT fractures are also treated by ORIF by separate incisions. CPT code 28615 would be reported for the fixation of the dislocation. CPT code 28485-59 would be reported three times to represent each metatarsal fracture, per CPT description of the code. *Modifier T, per CPT, would not be appropriate for these metatarsal shaft fractures. *• Percutaneous fixation of left tarsometatarsal dislocation with associated fracture at the base of the 2nd left metatarsal (it can be any one of five metatarsals) that is also stabilized by the percutaneous fixation of the dislocation: CPT code 28606 would be reported, per joint. Because the fracture is also fixed by the dislocation fixation, separate reporting may not be indicated.


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