Question: My podiatrist performed a primary ankle collateral ligament repair. In the medical documentation, they indicated they made five incisions to repair the single ligament. Am I allowed to report the same repair code five times on the claim?
RCI Subscriber
Answer: No, you would not report the same code more than one time on the claim. In this case, you should report 27695 (Repair, primary, disrupted ligament, ankle; collateral) only once despite the number of incisions your podiatrist made to repair the same ligament. Although the podiatrist made multiple incisions, they still only repaired a single ligament, so you would report 27695 only once on your claim.
If the podiatrist had repaired multiple lateral or medial ligaments on the same date of service, for example, then you could report multiple units of 27695 for each ligament repaired. If that were the case, you would then append modifier 59 (Distinct procedural service) when reporting 27695 for two or more repairs. By adding modifier 59 to the separate claims for the same dates of service, you are making sure the payer is aware these are not duplicate claims, but claims representing different services made on the same date. The practitioner’s notes should also specify which ligament(s) were repaired during the procedure.
For example: If your podiatrist repairs multiple ligaments in one of the collateral complexes, such as both the anterior talofibular and calcaneofibular ligaments in the lateral structure, and they make separate incisions for both ligaments, you will report:
Don’t forget: Make sure you specify the left or right foot by using the correct laterality modifier, RT (Right side) or LT (Left side), for the repair.
Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
