Podiatry Coding & Billing Alert

Rely on 28406 for the percutaneous treatment of calcaneal fractures.

When it comes to appropriately reporting calcaneal fractures, there is a lot of information you must keep track of like knowing whether your podiatrist performed open versus closed treatment or if he employed a graft.

Read on to learn helpful tips to make sure you don’t leave money on the table when submitting claims for calcaneal fractures.

Tip 1: Turn to 28400, 28405 for Closed Treatment

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

• If the podiatrist didn’t use manipulation, then report 28400 (Closed treatment of calcaneal fracture; without manipulation).
• If the podiatrist did use manipulation, then you should report 28405 (Closed treatment of calcaneal fracture; with manipulation).

Example: A patient comes into the office after falling in her yard. The podiatrist does an X-ray and confirms a calcaneal fracture. He performs plantar displacement of the forefoot and hindfoot to reduce the fracture. Then, he applies a short cast to stabilize the fracture. You would report 28405 for this service.

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 2: Keep This Percutaneous Code in Your Arsenal

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

Example: A patient comes in with a calcaneal fracture. The podiatrist treats the fracture by inserting distraction screws to externally fix across the calcaneal tuberosity, distal tibia, and the talus. In addition, the podiatrist inserted a cannulated screw from the lateral to the medial side into the sustentaculum tali. He used a lateral pin to manipulate the fracture fragments.

In this case, since the podiatrist used percutaneous fixation to repair the calcaneal fracture, you can report code 28406.

Percutaneous fixation requires pins to be placed through the skin and into the bone across the fracture line, according to Arnold Beresh, DPM, CPC, CSFAC,  in West Bloomfield, Michigan. In the operating room, the podiatrist usually uses X-rays or fluoroscopy and then manipulates the bone into alignment and uses a power pin driver to place the pin.

Tip 3: Podiatrist Used Open Treatment? Check Documentation for Graft

If the podiatrist treats the patient’s calcaneal fracture with open treatment, then you can look to code 28415 (Open treatment of calcaneal fracture, includes internal fixation, when performed).

Take a look at this scenario from Beresh about when you can appropriately report 28415: Mrs. Smith falls off a ladder while cleaning the gutters of the house. She lands on her right foot fracturing the calcaneus into three places. The podiatrist takes Mrs. Smith to the operating room and tries to align the bone. Unfortunately, he cannot align the bone and has to make a surgical incision and place a plate and screw across the fracture segments to realign and fixate the bone segments.

You would report 28415 for this service.

Don’t miss: When it comes to understanding the difference between codes 28406 and 28415, 28406 does not require a surgical incision whereas 28415 is an open surgical procedure that requires an incision, Beresh explains.

28420: When the podiatrist performs open treatment of a calcaneal fracture with a bone graft for reconstruction, you would 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 and the procedure includes obtaining the graft, Beresh says.