Podiatry Coding & Billing Alert

Question: Our physician recently performed “Arthroplasty/arthodesis of the second and third digits” and an “arthroplasty only of the fourth and fifth digits.” The podiatrist also performed an IM rod fixation of the left calcaneal tibial region. Implant of a bone stimulator. The notes state: 

“Using a #15 blade, excision of the eschar on the lateral aspect of the leg was completed. There was a small superficial wound and that was felt to excise as well. After this was performed, debridement of a nonviable bone over the lateral aspect of the foot was completed and also removal of all nonviable necrotic bone down to good bleeding based on tibia and calcaneal region was completed. A realignment was performed and a IM rod was placed from the plantar aspect of the heel using a standard protocol technique using fluoroscopic guidance in two planes. Subsequently, the IM rod was placed with the proximal and distal interlocks. Layered closure was performed and subsequent placement of the cast was done.”

How should I code these procedures?  

Ohio Subscriber

Answer: For arthrodesis of second and third digits, use code 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]). The arthroplasty would also be coded with 28285.

In arthrodesis, the provider makes an incision over the proximal interphalangeal joint. He uses a small blade to section, or cut, the ligaments from both sides. He exposes the proximal interphalangeal joint. He exposes the head and neck of the proximal phalanx, the toe bone closest to the body, and removes it with a rongeur. He completely removes the proximal phalanx. He then inserts a wire into the middle and proximal phalanges and fuses the proximal interphalangeal joint. The provider then irrigates the area, checks for bleeding, removes any instruments, and closes the incision. He applies a cast.

In an arthroplasty procedure, the physician makes an incision over the affected phalanx. He carefully retracts the nerves and tendons. The provider then identifies, exposes, and completely removes the affected phalanx using a bone saw. The provider then closes the surgical area in layers.

For the IM rod fixation of the calcaneal tibial region and implant of a bone stimulator, you should use CPT® code 27870 (Arthrodesis, ankle, open) for tibio-talar fusion and CPT® code 28725 (Arthrodesis; subtalar) for talo-calcaneal fusion.