Podiatry Coding & Billing Alert

Question: My podiatrist performed a primary ankle collateral ligament repair. In the medical documentation, he indicated that he made five incisions to repair this one ligament. My colleague and I agree that we should report 27695 on the claim, but we can’t agree how many times we should report the code. I say only once because although the podiatrist made numerous incisions, he only repaired the one ligament. My colleague thinks we should report 27695 more than once. Can you please settle our disagreement?

Wisconsin Subscriber

Answer: You are correct on this one. You should report 27695 (Repair, primary, disrupted ligament, ankle; collateral) only once despite the number of the incisions your podiatrist made to repair the same ligament. Although your podiatrist made multiple incisions, he still only repaired a single ligament, so you would report 27695 only once on your claim.

On the other hand, if your podiatrist had repaired multiple ligaments within the lateral or the medial, then you could report multiple units of 27695 for each ligament repaired. But, in this case, you must append modifier 59 (Distinct procedural service) when reporting 27695 for two or more repairs. The op notes should specify which ligament(s) your podiatrist repaired in the procedure. Make sure the documentation supports the different sites before you append modifier 59.

For example: If your podiatrist repairs multiple ligaments in one of the collateral complexes, such as both the anterior talofibular and calcaneofibular ligaments in the lateral structure, and he makes separate incisions for both ligaments, you will report:

• 27695
• 27695-59.

Don’t forget: Make sure you pinpoint either the left or right foot by using the correct location modifier, RT (Right side) or LT (Left side), for the repair.