Podiatry Coding & Billing Alert

Focusing on the differences between Achilles tendon repair codes is key.

When a patient experiences a ruptured Achilles tendon, the discomfort is typically instant and relentless. But the process of coding Achilles tendon services doesn’t have to be painful.

We’ll make this process painless for you with this review of the differences between Achilles repair codes. We’ll conclude by solidifying your understanding with a case study.

Know the Condition

A rupture of the Achilles is a severe injury involving a partial or complete tear of the Achilles tendon. This injury typically occurs due to a sudden force or stress on the tendon and is often experienced by athletes. This type of injury usually requires surgical intervention. When a patient has an Achilles rupture, they will experience pain and swelling at or near the heel. If they try to stretch, bend forward, or rise on their tiptoes, they will feel pain. At the time of the rupture, patients may also hear a loud popping sound.

Your podiatrist will diagnose an Achilles rupture when they perform a physical exam and by using X-rays or magnetic resonance imaging (MRI).

Turn to a Thompsen Test

A Thompson test is most frequently used to inspect the patient’s Achilles, according to Wayne Conway, CPC, CRC, CGSC, COSC, CRC, surgical orthopedic coder at Wake Forest University Baptist/Atrium Health. The provider will perform this test as a part of the exam the provider will perform during the initial office/ outpatient evaluation and management (E/M) service by squeezing the calf muscles while the patient is kneeling or lying face down with feet hanging unsupported.

The healthcare provider may decide to conduct an X-ray to eliminate the possibility of a fracture or dislocation. However, it is more probable that another type of imaging test will be performed.

“MRI [magnetic resonance imaging] and ultrasound [US] can confirm a diagnosis,” says Cathy Satkus, CPC, COBGC, of Harvard Family Physicians in Tulsa, Oklahoma.

When your provider performs an MRI or US, you’ll likely turn to one of the following codes for the service:

• 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation)
• 76882 (Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation)
• 73718 (Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s))
• 73719 (… with contrast material(s))
• 73720 (… without contrast material(s), followed by contrast material(s) and further sequences)
• 73722 (… with contrast material(s))
• 73723 (… without contrast material(s), followed by contrast material(s) and further sequences)

Don’t forget: Append modifier LT (Left side) or RT (Right side) to your MRI/US code to indicate laterality.

Report These Codes for Surgery

After the provider has determined the diagnosis of a ruptured Achilles, the next step will be to mend the damage. You’ll choose from the following codes when documenting an Achilles rupture repair:

• 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon). You should use this code for an acute, primary Achilles tear that your podiatrist repairs without a graft. This code is typically used in cases of an acute tear. Primary procedures are initial procedures to repair the tendon.
• 27652 (… with graft (includes obtaining graft)). You should report this code for an acute, primary Achilles tear that your podiatrist uses a graft to repair. This code is typically used for a repair of a more complicated rupture. According to 27652’s code descriptor, you can report this code if the primary repair is either open or percutaneous (meaning performed through the skin).

If your podiatrist performs a secondary Achilles repair instead of a primary repair, you should report code 27654 (Repair, secondary, Achilles tendon, with or without graft). You will most likely encounter this scenario when the patient has an old tear or has re-torn a previous repair and has major retraction or tendon scarring. For example, you’ll report 27654 if a primary repair failed; if the patient experienced a re-tear, code 27654 would be appropriate. Code 27654 could also be used for repair of a chronic tear where scar tissue and adhesions have formed. This sometimes will alter anatomy and make repairs more difficult. Per CPT^® Assistant, code 27654 may also be reported for “debulking” of a diseased Achilles tendon.

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

Don’t miss: You should not separately report the harvesting of the tendon graft, if performed, because this service is included in any grafting procedure associated with Achilles tendon repair.

Coding example: The podiatrist takes the patient into surgery after diagnosing an Achilles tendon rupture of the right heel. The podiatrist’s initial thought is to perform a percutaneous repair, but they are not able approximate the edges. So, they convert the procedure to an open procedure and use a graft to supply length to make the repair and allow for proper positioning of the foot. In this scenario, you would report 27652 with modifier RT appended and S86.011A (Strain of right Achilles tendon, initial encounter) on your claim, according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.