Podiatry Coding & Billing Alert

If you see in the medical documentation that your podiatrist performed arthrodesis, then he surgically immobilized a joint by fusing bones. Your podiatrist can perform many different types of arthrodesis on a patient’s feet and toes.

Read on to learn more about the most common types of arthrodesis your podiatrist may perform in your practice.

Rely on These Procedure Codes for Tarsometatarsal Arthrodesis

CPT^® offers you several codes to report tarsometatarsal arthrodesis, so you will need to check the medical record to see which how many joints your podiatrist immobilized and whether he performed an osteotomy or not.

Take a look at your code choices for tarsometatarsal joint arthrodesis:

• 28730 (Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse)
• 28735 (... with osteotomy (eg, flatfoot correction)
• 28740 (Arthrodesis, midtarsal or tarsometatarsal, single joint)

Midtarsal joints defined: The midtarsal joints are the combined joints of either the talus with the navicular bone or the calcaneum with the cuboid bone.

Tarsometatarsal joints defined: Tarsometatarsal joints can also be called are Lisfranc joints. They are the joints of the first, second, and third cuneiforms, and the cuboid with the bases of the metatarsal bones.

Code 28730: As the descriptor for code 28730 suggests, when your podiatrist performs this procedure, he surgically immobilizes multiple or transverse midtarsal or tarsometatarsal joints.

Code 28735: You should report code 28735 when your podiatrist performs arthrodesis of multiple of transverse midtarsal or tarsometatarsal joints with an osteotomy.

Code 28740: You should report code 28740 when your podiatrist performs arthrodesis of a single midtarsal or tarsometatarsal joint.

Don’t miss: If your podiatrist performs joint fusion at the tarsometatarsal joint to treat a bunion deformity, then you could report this service with code 28297 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method), according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Report 28715 for Triple Arthrodesis

In the medical documentation, you may see that your podiatrist performed a triple arthrodesis. This is typically performed in patients with degenerative arthritis or trauma. During this procedure, your podiatrist will fuse the three joints of the ankle (the subtalar, the talonavicular and the calcaneocuboid s) together to completely mobilize the ankle joint.

You should report code 28715 (Arthrodesis; triple) for this procedure.

Discover This Subtalar Arthrodesis Scenario

Sometimes your podiatrist may need to perform subtalar arthrodesis. During this procedure, your podiatrist will make a curved incision around the patient’s calcaneus to the level of the subtalar joint. He will remove the lateral talar process for better exposure. The podiatrist will incise the talocalcaneal joint capsule to further view the subtalar articulation. He will also excise the patient’s articular cartilage and subchondral bone, including the anterior, middle, and posterior facets.

You would report 28725 (Arthrodesis; subtalar) in this case.

Understand Great Toe Arthrodesis Codes

If your podiatrist performs arthrodesis on the patient’s great toe, you can either report code 28750 or code 28755, depending upon which joint the podiatrist performs the fusion at.

Code 28750: If your podiatrist performs arthrodesis of the metatarsophalangeal joint of the patient’s great toe, you should report 28750 (Arthrodesis, great toe; metatarsophalangeal joint).

Code 28755: On the other hand, you should report 28755 (Arthrodesis, great toe; interphalangeal joint) if your podiatrist performs arthrodesis on the interphalangeal joint of the patient’s great toe. The goal of a 28755 procedure is to treat pain in patients who suffer from end-stage osteoarthritis of an interphalangeal joint of the great toe.

Putting it All Together With An Example

Coding problem: The patient has pain related to end stage osteoarthritis of the midtarsal joints. The podiatrist made an incision over the affected joints in front of the patient’s ankle. He dissected down through subcutaneous tissue, preserving the nerves and veins. He then retracted the muscle to gain access to the joints, where he cut the joint capsule and entered the joint. He removed all of the dead tissue from the joint cavity. He brought the bones of the joints in close proximity and fused three joints with K-wire. According to the documentation, the podiatrist fused three joints.

Coding solution: You should report 28730 for this procedure. You would report 28730 when the podiatrist fuses multiple joints, as the descriptor for this code specifies. However, you should report 28730 only once, even though the podiatrist fused multiple joints. Since the code descriptor includes the term “multiple,” you do not need to list it more than once or append any modifiers.