Podiatry Coding & Billing Alert

Question: I am billing for an outpatient surgical procedure for the right foot. The podiatrist performed a bone-block wedge arthrodesis of the right second and third M-C right foot. Then he did a graft (calcaneus) and planting on the foot? Operation report stated the graft was the second procedure. How should code this encounter? Do I need any modifier?

Missouri Subscriber

Answer: According to your information, the arthrodesis should be reported with 28730 (Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse). In this procedure, the physician surgically immobilizes multiple or transverse midtarsal or tarsometatarsal joints (also known as Lisfranc joints) with the help of fixation devices. They are the joints of the first, second, and third cuneiforms, and the cuboid with the bases of the metatarsal bones. The goal of this procedure is to treat pain in patients with end stage osteoarthritis of midtarsal or tarsometatarsal joints.

The podiatrist makes an incision in the skin over the affected joints in front of the ankle and retracts the muscle to gain access to the joints to be fused. After cutting the joint capsule, entering the joint, and removing all dead or inflamed tissue from the joint cavity, he brings the bones of the joints in close proximity and fuses the joints using implants. He may also use a cancellous bone graft to fuse the joints to provide extra stability. You can report the graft procedure with code 20900 (Bone graft, any donor area; minor or small [e.g., dowel or button]). The bone graft restores structural integrity and natural osseous, or bony tissue to the site of a bony defect, which increases its strength so it will last over a period of time. Your physician may have obtained the bone graft from the iliac crest or ribs; however, the preferred site is the fibula because of its versatility, shape, size, and strength.

You should not use the modifier 51 (Multiple procedures) on 28730. Modifier 51 is used for multiple procedures and you would not put a modifier on the primary procedure. You should assign the 51 modifier to the 20900. However, you will need to attach bilateral modifier RT (Right side [used to identify procedures performed on the right side of the body]) to the codes to identify the part of the body operated on.