Podiatry Coding & Billing Alert

Hint: Make sure you know whether it’s a primary or secondary repair.

Think you aced the Achilles tendon repair coding quiz? Test your knowledge and check your answers against our experts’.

Question 1: You should report 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon) when the podiatrist performs a primary Achilles repair without a graft.

“For 27650, which usually represents an acute [Achilles] tear, the patient would present with sudden lower extremity pain, usually around the ankle or calf. Patients often describe the injury as ‘like being struck from behind’ in the area of the injury,” says Denise Paige, CPC, COSC, with Bright Health Physicians in Whittier, California. “This injury often occurs while playing sports or other high-impact activities. Sometimes the tendon ruptures spontaneously with no specific injury.”

Don’t miss: For 27650 claims, “the diagnosis should indicate laterality, initial or subsequent care, along with the use of the LT (Left side) or RT (Right side) modifier on the CPT^® code,” Paige adds. Also, your notes should include any indications that it’s due to an injury or a spontaneous rupture, if available.

Question 2: You should report code primary Achilles surgeries that employ some sort of graft with 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)). The provider will typically perform 27652 service for patients with a more complicated Achilles rupture, according to Paige.

Very often, the notes make it clear that the surgeon used a graft during the Achilles repair.

“There are a few different types of grafts that could be used,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, staff services coordinator/billing/credentialing/auditing/coding at County of Stanislaus Health Services Agency in Modesto, California.

Often, encounter notes for Achilles repair contain documentation “referencing various ‘flaps’ that will be sutured or woven to the ruptured site,” Johnson explains. If you see notes indicating flaps sutured or woven to the injured area, it’s pretty likely the surgeon performed a graft.

Question 3: The most common symptoms of an Achilles rupture include “pain and swelling at or near the heel. Any stretching of the site will be painful, such as bending forward, or pushing off; going on tip toes should be impossible or cause extreme pain,” according to Johnson. Some patients will also describe a “popping” sound at the time of the injury and immediate sharp pain.

Don’t miss: The podiatrist will typically discover an Achilles rupture during an evaluation and management (E/M) service and/or via X-rays or a magnetic resonance imaging (MRI). So, depending upon the situation, you may be able to code for these services. However, always ask the performing physician to double-check for certain if there are any other services you should code with the Achilles repair.

Question 4: If the podiatrist performs a secondary Achilles repair, you should 27654 (Repair, secondary, Achilles tendon, with or without graft). The physician would likely perform a secondary repair “for an old tear or a re-tear of a previous repair with significant retraction or scarring of the tendon. The indications should be clearly stated in the op note along with the use of the graft,” Paige says.