Podiatry Coding & Billing Alert

Understanding primary vs. secondary procedures is key.

When your podiatrist hands you a chart documenting a Brostrom procedure, you may not instinctively know which code to report, particularly since this surgery is often considered a secondary repair. With these simple but essential pointers, however, you’ll be on the way to streamlined Brostrom procedure coding that will allow you to bring in maximum pay.

1. Seek These Documentation Clues

When the podiatrist performs a Brostrom procedure, the documentation should indicate a repair of the lateral ligament, which is on the outside of the ankle. The podiatrist will likely document addressing the anterior talofibular ligament (ATFL), which they will cut and repair to tighten it so it’s more stable in the future. The podiatrist may also perform a calcaneofibular ligament (CFL) reconstruction during the procedure.

The documentation will also typically note a history of recurrent sprains to the ankle, since the intent of the Brostrom procedure is to stabilize ligaments that became loose over time due to repeated injuries to the area.

What the documentation likely won’t include, however, is notation of an emergency. Brostrom repairs are typically performed following a series of wear and tear-type injuries rather than a single acute injury affecting the ankle.

2. Don’t Mix up Secondary, Primary

One source of confusion when selecting the right CPT^® code involves differentiating secondary and primary procedures from one another. The documentation of the surgeon should clarify which was performed.

“It is the surgeon’s responsibility to dictate what ligaments were repaired: if it was a primary repair, if a secondary repair was performed, and by what method,” said David Bishop, DPM, AACFAS, assistant residency director at Aultman Alliance Community Hospital, Alliance, Ohio. “Lack of clear dictation of the performed method can result in the  inability for the coder to justify billing the code desired. I personally attempt to use the exact wording of the code I wish to use.”

Most coders will read the Brostrom documentation and narrow down their coding choices between the following two codes:

• 27695 (Repair, primary, disrupted ligament, ankle; collateral)
• 27698 (Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure))

While 27695 describes a “primary” repair, 27698 refers to a “secondary” procedure. And although those terms may not be familiar to every coder, here is a simple explanation that will help you distinguish between them:

“The terms ‘primary’ and ‘secondary’ in the code descriptors denote that code 27695 is reported for an acute injury repair, and code 27698 is reported for a chronic injury repair,” according to the March 2014 issue of CPT^® Assistant. “If the surgeon performs a secondary repair, the repair is a reconstruction (code 27698), regardless of when it was done in relation to the time of the initial injury. A primary repair refers to joining two ends of the ligaments together, whereas a secondary repair requires other tissue to be used to do the repair because a primary repair is no longer possible.”

Therefore, the Brostrom procedure (a secondary repair) is best reported using 27698 and not 27695. Although it’s considered a secondary procedure, 27698 is actually the higher-paying surgery, reimbursing about $653, while 27695 reimburses about $492. So it is important you code the procedure your podiatrist actually performed correctly.

As noted above, the podiatrist might address both the ATFL and the CFL during the Brostrom procedure, but that doesn’t mean you can report a second code for this surgery. Code 27698 includes all of the work done repairing both ligaments as part of the procedure.

3. Consider 27658 for Tendon Repairs

Although ligament repairs are described by 27698, you can — and should — submit an additional code if the surgeon repairs the flexor tendon during the surgery. You’ll select the most appropriate repair code depending on the documentation, but typically it will be one of the following: