Podiatry Coding & Billing Alert

Question: Our podiatrist saw a patient. His MRI stated that no actual fracture of the bones was found but a dislocation of the tarsometatarsal joints was noticed.

The physician’s notes show:

-- stabilization under traction and local pressure for Lisfranc fracture dislocation joints 1,2,3,4, and 5.

-- introduced percutaneously K-wires to from the base of the 2nd, 3rd, and 4th metatarsals into the middle tarsals.

How should I code this Listfranc scenario? Is there a difference between fracture of a joint versus dislocation? I am considering billing the 28606 × 3. Does code 28606 include the closed reduction? He reduced all five tarsometatarsal joints but pinned only three.

Colorado Subscriber

Answer: You should report this encounter with code 28606 (Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation). You can report a Dx code 838.03 (Closed dislocation of tarsometatarsal [joint]) to support the procedure. The podiatrist will first reduce the tarsometatarsal joint dislocation and then will manually adjust the bones by pushing or pulling to bring them back to their normal alignment. He will create a small incision in the skin over the dislocated joint to inserts pins and screws through to hold the reduced dislocation in place, before closing the wound. Closed reduction is included in CPT® 28606. As your physician has stabilized the dislocation under traction and local pressure in the joints 1, 2, 3, 4, and 5 and reduced them, but pinned only three, you should code 28606 only once. As per the notes, skeletal fixation was performed, which means the fracture is neither open nor closed, but the site is closed by application of pins, wires, or screws as needed. This code includes multiple pins or screws.

A fracture means a breaking or cracking of the bone/s of the feet/ankle. There are several types of fractures, however, a fracture is called closed if there is no break in the skin and is known as an open fracture if the bone fragment has broken the skin or there is a wound present along with the fracture. Loss of normal positioning of a fractured extremity can obstruct blood flow to the affected limb. A dislocation means displacement of two bones that become out of place at the joint that connects them. There is a risk of injury to nerves and blood vessels in case of a dislocation. There is greater chance of repeat dislocation for joints that become dislocated and later heal.

The Lisfranc joint is the point at which the metatarsal bones (long bones that lead up to the toes) and the tarsal bones (bones in the arch) connect. The Lisfranc ligament is a tough band of tissue that joins two of these bones. Injuries can range from simple ligament sprains to complete disruption of the TMT joint. Lisfranc fracture is a fracture in which one or all of the metatarsals are displaced from the tarsus (means dislocation).