Podiatry Coding & Billing Alert

Question: The patient came in with extreme pain and swelling of their left heel. The patient was playing volleyball and landed incorrectly on their foot. They reported hearing a popping sound after the injury occurred. The podiatrist conducted an examination and used magnetic resonance imaging (MRI) to identify a ruptured Achilles tendon in the patient. Given that the injury was identified as an acute tear of the Achilles, the decision was made to proceed with a primary repair without the use of a graft. What CPT® and ICD-10-CM codes should I report on my claim?

AAPC Forum Participant

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). For more claim detail, you should also report the external cause code Y93.68 (Activity, volleyball (beach)(court)).

Don’t miss: For this type of the scenario, the patient usually has an acute Achilles tear, and they will present with sudden lower extremity pain, normally around the ankle or calf. Often, 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 to point to.

Documentation tip: When your podiatrist performs a primary Achilles repair, you must first check the medical documentation to see if they did or did not use a graft 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 the 27650 code descriptor, you can report this code if the repair is either open or percutaneous.

According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC, in Bella Vista, Arkansas, “Documentation would be expected to show that diagnostic imaging confirmed the diagnosis of the rupture. The approach, as well as the techniques used, such as Krakow, Bunnell, or modified Kessler suture techniques — which aim to securely reattach the tendon ends while minimizing tension and ensuring proper alignment for optimal healing — would also need to be noted.”

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.

If your practitioner did use a graft, you would report code 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)) instead.