Podiatry Coding & Billing Alert

Question: The patient came in with extreme pain and swelling of her left heel. She was playing basketball and landed wrong on her foot. She reported hearing a popping sound after the injury occurred. My podiatrist performed an exam and MRI to diagnose the patient with a ruptured Achilles tendon. Since my podiatrist determined the injury as an acute Achilles tear, he chose not to use a graft during this primary repair. What CPT^® and ICD-10-CM codes should I report on my claim?

Texas Subscriber

Answer: You should report 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon) with the LT (Left side) modifier appended on your claim. For the ICD-10-CM code, you will report S86.012A (Strain of left Achilles tendon, initial encounter).

Don’t miss: For this type of the scenario, the patient usually has an acute Achilles tear, and he will present with sudden lower extremity pain, usually around the ankle or calf. Oftentimes, the patient will sustain this type of Achilles tear while playing a sport or other high-impact activity. However, sometimes the tendon can rupture spontaneously with no specific injury.

Documentation tip: When your podiatrist performs a primary Achilles repair, you must first check the medical documentation to see if he used a graft or not because this information will impact your CPT^® code choice. If your podiatrist performs a primary Achilles repair without a graft, you should report 27650 According to 27650’s code descriptor, you can report this code if the repair is either open or percutaneous.

Also, when you report 27650 on your claim, you must make sure that your podiatrist’s documentation specifies whether the tear was due to an injury or to a spontaneous rupture.