Podiatry Coding & Billing Alert

Question: The patient had a displaced fracture of the body of the right calcaneus caused by a fall. This was an initial encounter for a closed fracture. The podiatrist treated the patient’s calcaneal fracture with open treatment. They used internal fixation with a bone graft for reconstruction. Which ICD-10-CM and CPT^® codes should I report on my claim?

Alabama Subscriber

Answer: You should report S92.011A (Displaced fracture of body of right calcaneus, initial encounter for closed fracture) on your claim.

Since your podiatrist performed open treatment of the calcaneal fracture with a bone graft for reconstruction, you should report 28420 (Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)).

Code 28420 uses a bone graft either from the iliac crest, which in most states would have to be done by an orthopedic surgeon and you would append modifier 62 (Two surgeons); or other autogenous bone graft (the procedure includes obtaining the graft).

Don’t miss: Code 28420 isn’t the only option you have when your podiatrist treats the patient’s calcaneal fracture with open treatment. You can also look to code 28415 (Open treatment of calcaneal fracture, includes internal fixation, when performed). Code 28415 is an open surgical procedure and requires an incision.