Podiatry Coding & Billing Alert

Question: The patient came in for right tarsometatarsal (TMT) joint fusion, which I thought would be initially reported as 28740 (Arthrodesis, midtarsal or tarsometatarsal, single joint). However, my podiatrist then pinned/screwed the right first and second cuneiform bones together. According to the documentation, there was widening of the joint with stress under C-arm fluoroscopy. The patient had a hypermobile foot. Therefore, a K-wire was placed medial to lateral across the 1-2 cuneiform joint. My podiatrist over reamed the proximal aspect of the pin. They then used a countersink on the medial aspect of the bone. A 23mm x 3.5 mm transverse Lapiplasty screw was placed over the wire. Does this additional “fixing” of the 1-2 cuneiform bones after the fusion of the first tarsometatarsal support an additional “arthrodesis?” Does screwing two bones together indicate a “fusion” of that joint? Would you report 28730 (Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse) for “multiple or transverse?” If no, what would you report for the fixing of the 1-2 cuneiforms, in addition to the 28740?

AAPC Forum Participant

Answer: No, this is not an additional fusion. In order to fuse, the podiatrist has to remove the joint surfaces and create bleeding bone so the two joints can fuse. The drilling around the screw and countersinking are all part of placing the screw. Many podiatrists are doing this with their Lapidus procedures and trying to bill for an additional fusion. CPT^® Assistant also published an article saying, no, this is not a fusion.

Why was the first TMT fusion done? What is the diagnosis, as this very much sounds like a Lapidus? If the diagnosis was for hallux valgus, this should not be coded as 28740 but as 28297. If it is being done for a different reason, then 28740 is appropriate.