Orthopedic Coding Alert

Question: A patient came in with extreme pain and swelling of her left heel. She was dancing in her ballet class and landed wrong on her foot. She reported hearing a popping sound after the injury occurred. My provider performed an exam and magnetic resonance imaging (MRI) to diagnose the patient with a ruptured Achilles tendon. My provider performed a primary repair of the ruptured Achilles tendon. Since my provider determined the injury as an acute Achilles tear, he chose not to use a graft during this primary repair. Which codes should I report on my claim?

New York Subscriber

Answer: You should report 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon) with the LT (Left side) modifier appended on your claim. For the ICD-10-CM code, you will report S86.012A (Strain of left Achilles tendon, initial encounter).

Don’t miss: On the other hand, if your provider performs a primary Achilles repair and uses a graft, you should report 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)). Your provider will typically perform this type of repair for a more complicated Achilles rupture.

According to 27652’s code descriptor, you can report this code if the primary repair is either open or percutaneous.

Caution: Your provider’s notes should make it clear that he used a graft during the Achilles repair. If your provider says that he used “various flaps sutured or woven to the ruptured site,” this is a likely indication that he used a graft for the repair.

Don’t miss: You should not separately report the harvesting of the tendon graft, if performed, because this is an included service.