Podiatry Coding & Billing Alert

Report either 28400 or 28405 for closed treatment of calcaneal fracture.

If you report calcaneal fractures in your podiatry practice, you must double-check the documentation for numerous details including the exact type of calcaneus fracture and what type of treatment your podiatrist used to treat the injury.

Read through the following rules to make sure you submit clean calcaneus fracture claims in your practice.

Rule 1: First, Pinpoint ICD-10-CM Codes for Calcaneus Fractures

Calcaneus fractures are mostly caused by high-impact injuries such as accidents or falls. Your podiatrist will order an X-ray to determine the exact location of the fracture. Your ICD-10-CM code options for calcaneal fractures are as follows:

• S92.01XX (Fracture of body of calcaneus)
• S92.02XX (Fracture of anterior process of calcaneus)
• S92.03XX (Avulsion fracture of tuberosity of calcaneus)
• S92.04XX (Other fracture of tuberosity of calcaneus)
• S92.05XX (Other extraarticular fracture of calcaneus)
• S92.06XX (Intraarticular fracture of calcaneus)

Calcaneus defined: The calcaneus is located at the bottom of the foot and part of the heel.

Don’t miss: The seventh character of the above codes will specify the type of encounter. Your choices are as follows:

• A (Initial encounter for closed fracture)
• B (Initial encounter for open fracture)
• D (Subsequent encounter for fracture with routine healing)
• G (Subsequent encounter for fracture with delayed healing)
• K (Subsequent encounter for fracture with nonunion)
• P (Subsequent encounter for fracture with malunion)
• S (Sequela)

Example: The patient has a displaced fracture of the body of the right calcaneus. This is an initial encounter for a closed fracture. You should report S92011A (Displaced fracture of body of right calcaneus, initial encounter for closed fracture) as the ICD-10-CM code on your claim.

Rule 2: Report These Codes for Closed Treatment

If your podiatrist performs closed treatment for a calcaneal fracture, you should look to the following codes:

• 28400 (Closed treatment of calcaneal fracture; without manipulation). Note: If your podiatrist didn’t use manipulation, you should report 28400.
• 28405 (Closed treatment of calcaneal fracture; with manipulation). Note: If your podiatrist does use manipulation, you should report 28405.

Don’t miss: You should not separately report 29405 (Application of short leg cast (below knee to toes)) for the cast application, as this is included in the treatment code 28405.

“CPT^® codes for closed, percutaneous, or open treatment of fractures or dislocations include the application of casts, splints, or strapping,” according to the National Correct Coding Initiative Policy Manual for Medicare Services. “CPT^® codes for casting/splinting/strapping shall not be reported separately.”

Tip 3: Focus on Codes for Open Treatment

If your podiatrist treats the patient’s calcaneal fracture with open treatment, you have two choices.

First, you can look to code 28415 (Open treatment of calcaneal fracture, includes internal fixation, when performed). Code 28415 is an open surgical procedure and requires an incision.

On the other hand, if your podiatrist performs open treatment of a calcaneal fracture with a bone graft for reconstruction, you should report 28420 (Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)).

Code 28420 uses a bone graft either from the iliac crest, which in most states would have to be done by an orthopedic surgeon and you would append modifier 62 (Two surgeons); or other autogenous bone graft (the procedure includes obtaining the graft).

Rule 4: Rely on This Code for Percutaneous Skeletal Fixation

If your podiatrist uses percutaneous skeletal fixation to treat a calcaneal fracture, you should report 28406 (Percutaneous skeletal fixation of calcaneal fracture, with manipulation).

When your podiatrist used percutaneous fixation, they place pins through the skin and into the bone across the fracture line, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. Your podiatrist will use X-rays and fluoroscopy in the operating room (OR) and manipulate the bone into alignment. They will use a power pin driver to place the pin.

Your podiatrist may often choose percutaneous skeletal fixation to treat a calcaneal fracture for a patient with inadequate soft tissues, such as a diabetic patient.