Podiatry Coding & Billing Alert

Question: What code should we report for a primary ankle ligament repair?

Wisconsin Subscriber

Answer: Before coding the ligament repair, review the op notes to capture the number of ligaments and incisions the podiatrist operated on. If the podiatrist makes a fresh repair on any one of the ligament structures — medial or lateral — this is a primary repair. In this case, you should report code 27695 (Repair, primary, disrupted ligament, ankle; collateral).

Caution: You should report 27695 only once despite the number of the incisions the podiatrist makes to repair the same ligament. If the podiatrist makes multiple incisions to repair a single ligament, still report 27695 only once.

Don’t forget: Make sure you pinpoint either the left or right foot by using the correct location modifier, RT (Right side) or LT (Left side), for the repair.

Multiple ligaments: However, if the podiatrist repairs multiple ligaments within the lateral or the medial, then you can report multiple units of 27695 for each ligament repaired. But, you must append modifier 59 (Distinct procedural service) when reporting 27695 for two or more repairs. The op notes should specify which ligament(s) the podiatrist repaired in the procedure. Make sure the documentation supports the different sites before you append modifier 59.

For example: If the podiatrist repairs multiple ligaments in one of the collateral complexes, such as both the anterior talofibular and calcaneofibular ligaments in the lateral structure, and he makes separate incisions for both ligaments, you will report:

• 27695
• 27695-59.