Podiatry Coding & Billing Alert

Question: An athlete patient presented to the office with Listfranc joint injuries. The podiatrist used the common open reduction internal fixation (ORIF) technique to repair a fracture to the Lisfranc area. How should I bill the procedure?

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Answer: The key on coding for multiple fractures is to treat each fracture repair as one unit. In this case, your approach should be based on the anatomy, which would normally merit three units of 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each), one for each of the metatarsal fracture. Remember to add modifier 59 to 28485 beginning with the second line item.

Reimbursement: CPT 28485 represents fractures in separate metatarsals, not multiple fractures within the same metatarsals. It carries 13.91 physician work relative value units (RVUs), according to the 2010 Medicare Physician Fee Schedule. That translates to $512.90 per metatarsal based on the updated 2010 national conversion factor of $36.8729.

-- Answers to You Be the Coder and Reader Questions were reviewed by Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.