Wiki HELP WITH CPT CODE FOR NAVICULAR AND CUNEIFORM ARTHRODESIS

[CCANTER]

The procedure is Navicular cuneiform arthrodesis.

My provider has listed CPT code 28730. But i was thinking 28740 for one joint?

NC fusion performed with staples and noted have good position. the navicular and cuneiform was feathered down with a sagittal saw. This allowed good contact at the NC joint. 2 staples were inserted and noted to have good compression across the NC site.

 

[amyjph]

Good question. I think if it was two or three cuneiforms/navicular I might do 28730 too. If it was only one probably 28740. Did you check to see if there's a CPT Assistant on this?

 

[Orthocoderpgu]

The procedure is Navicular cuneiform arthrodesis.

My provider has listed CPT code 28730. But i was thinking 28740 for one joint?

NC fusion performed with staples and noted have good position. the navicular and cuneiform was feathered down with a sagittal saw. This allowed good contact at the NC joint. 2 staples were inserted and noted to have good compression across the NC site.

Why is this procedure being performed? Diagnosis?

 

[amyjph]

Good question, also was that the only procedure during the case?

 

[CCANTER]

Why is this procedure being performed? Diagnosis?

here are the procedures and diagnosis that were performed
and then i was questioning because 28300 and 28730 bundle. and i saw there was a different cpt code for the arthrodesis with osteotome?

sorry i havent coded much for podiatry so i am new to this and really am struggling thank you for all your help
POSTOPERATIVE DIAGNOSES
1. Right ankle TAR failure
2. Right ankle traumatic arthritis.
3. Right ankle history of TAR
4. Right ankle pain
5. Hindfoot valgus
6. Pes planus

OPERATION
1. Right total ankle arthroplasty with implant.
2. Right calcaneal osteotomy
3. Right NC arthrodesis
4. Right total ankle implant removal

 

[amyjph]

Okay, this is a way bigger case. It is always helpful when asking case questions in the forums, especially about surgeries, that all the procedures are listed. If it is a one-liner small case like just a TMT fusion that is very different from what you have here.

With foot and ankle (or hand or really any big surgery) it is helpful when learning to break it down into pieces. So, write what you think the diagnoses and procedures are from the header, then go look for them being described/stated in the body of the op note. Once you do that and look up codes to make sure what you think it was from the header is what really happened, then you have to order them by RVUs and check your bundling/inclusive and other edits. With F&A it is also helpful to have a dry erase type foot and ankle anatomy photo or one you can print and write on or color if it's a really big case.

This one from the header you have is a patiet with a failed total ankle and other deformity, flat foot, OA, etc.

What codes did you come up with for this so far?

 

[CCANTER]

so i have CPT code 27703 for the total revision, 28300 for the calcaneal osteotomy, and the one i am struggling is with the nc arthrodesis. If its 28730 or 28740 or even actually a different cpt code? i do know that 28300 bundles with 28730 and however is a modifier appropriate?

 

[amyjph]

It would be helpful to see what exactly was done in the body of the report. You are correct with 27703 & 28300. If it was all three cuneiforms and the navicular I would probably use 28730. I don't understand why 28300 bundles with 28740 or 28730. Interestingly (I don't have a current year version) the AAOS GSD book shows neither 28740/28730 as being included in 28300. 28730 does not show 28300 being included. Both of those are silent on it. However, when you look up 28740 it shows 28300 is included. I would be more inclined to report either 28740 or 28730 (depending on what is decided) because either one has a higher RVU than 28300. 28730 or 28740 both shows bundling edits for standards of med/surg practice in NCCI. Not sure if it warrants a 59 or not. I don't have access to CPT Assistant right now to see if there is anything in there about it. Maybe another ortho coder has info for us. It also depends on the body of the report and the intent of the procedures.

Some reading info:

https://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/you-be-the-coder-dig-for-arthrodesis-details-157224-article

 

[CCANTER]

here is the op note. I appreciate everyone's input
An anterior incision was made overlying the ankle and taken down with careful dissection. All neurovascular structures were ligated. Retractor cauterized as needed. Longitudinal capsulotomy was made and the soft tissues were reflected off the distal tibia and talus. The previous tibial and talar implant were removed.

Inbone jig applied and foot pinned down. The jig was checked and set in AP/LAteral views.

The tibial tray was placed on the area this was a used with the M bone jig. The tibial cut was sized and checked on fluoroscopy multiple times. This was resected and removed in total. This had a nice stable appearance. Talus cut performed. All bone was removed.

Tibial reaming was performed through the plantar incision. This was done after the in bone jig was appropriately placed. Reaming was performed and the implant was built. We placed a invision implant Talus was sized and invision tray and dome fixated. Poly trialed and size 12 inserted. Noted appropriate tension of the joint.

Lateral incision was made over the posterior calcaneus and the orientation of the peroneal tendons. This is taken down careful dissection the peroneal tendons were visualized and retracted distally. A periosteal incision was made and a sagittal saw was used to resect the bone from lateral to medial. Osteotomes used to separate the area. The capital fragment was translated medially reducing the valgus of the heel. This was checked on fluoroscopy and pinned and noted to have good position. Ortho solution screws were drilled and inserted according manufacture specifications. Again noted to have good compression of the osteotomy site. There is noted have nice appearance and again reducing the valgus heel on fluoroscopy. Everything is copiously irrigated and closed with 3-0 Monocryl 4-0 Monocryl on the skin.

NC fusion performed with staples and noted have good position. the navicular and cuneiform was feathered down with a sagittal saw. This allowed good contact at the NC joint. 2 staples were inserted and noted to have good compression across the NC site.

Everything was copiously irrigated. Postoperative fluoroscopy showed a rectus ankle with tibiotalar overlap. Good compression of implants/bony interface Was noted.

Hemovac drain inserted. Everything was dressed with Adaptic, 4x4s, Sof-Rol. Patient was placed in a very well-padded posterior splint with 4 and 6-inch Ace coverage. Tourniquet was deflated and had cap refill time of the digits.