Coding Updates for Foot and Ankle (Tendons, Joints and Incisions)


The coding for foot and ankle can be confusing and more so when it comes to single tendons or multiple tendons; or single joints or multiple joints; or single incision or multiple incisions. Why are they different than what we see in any other area of the CPT book? In the foot tenolysis codes, there are codes related to flexor tendons and there's codes related to extensor tendons. And they both are defined in the same way. And if you look at the description of these codes, it talks about, exactly how it is written and the fact that if you're doing a tenolysis in the foot and you're only doing one tendon; you're going to bill -28220. But if you're doing multiple tendons within the foot, you're going to use -28222. Now, there's no definition of how many tendons this is. So, whether you're doing two tendons or eight tendons, you still need to use -28222 and it will represent any and all tendons that you've done; kind of an unhappy thing in the fact that we may not get credit for all of those tendons because there's one code to report multiple tendons.
Most insurance carriers, if you divide these out and bill -28220 with a quantity, unless you're doing it in both feet, they're going to deny it as being unbundled. So you need to use appropriate codes. The same thing with the extensor tendons, they have one for any single tendon within the foot. And then if you're doing multiple tendons in the foot, you need to use the multiple tendon code. A lot of times the physicians don't want to use multiple tendons if it's multiple tendons within the same toe. Well, no, we're not talking about toes here. We're talking about the foot. So these are the tendons when they're running across the foot area; not the toes.

Now let’s take a look at the tenotomy, there are two ways of performing it—open or percutaneous. And again, we have the tendons which is either single or multiple. And this is also done in the crease of the toe. So, it's really done at the upper portion of the foot. According to latest medical coding updates, if you distinctly look at these codes though, -28010 and -28011 specifically say “toe”. This is actually different than the tenolysis in the foot, where if you're performing a percutaneous tenotomy on one tendon in the toe, you're going to use -28010. On the other hand, if you're doing multiple tendons in the toe, you're going to use -28011 but this is by toe. In this case, you can use your different toe modifiers. And say for instance, you're doing a single tendon in one toe and multiple tendons in another toe, and then you can use these codes.

If we look at the open, we see there are two codes related to flexor, -28230 is if you're doing in the foot and whether you're doing single tendons or multiple tendons in the foot area, you're going to use this one code. If you're doing flexor tenotomy in a toe and it's a single tendon, you're going to use -28232. If you are doing extensor tendons, there is one code for either foot or toe and it's by tendon. It gets a little bit complicated and you really have to be careful of deciding, “Are we doing this in the foot? Or are we doing it in the toe?” And then you want to make sure that you get credit or report the codes specifically by whether it's foot or toe in multiple tendons or single tendons. You have to be really careful to make sure you get everything reported appropriately.

Other tendon procedures within the ankle, -27681 are if you are doing tendon tenolysis in the ankle. And if you notice, this code actually describes if in fact you're doing multiple tendons and if you're doing separate incisions, you're going to use -27681. If you're doing multiple tendons through the same incision in a lengthening or shortening of a tendon, you're going to use -27686.

Now, what I want to point out here is we normally don't see procedure codes that incorporate multiple incisions; -27681 specifically give that description that separate incision is included here. So the doctors don't like again this one because they say, “Well, if I'm doing a flexor or extensor tendon in the leg or ankle,” and again, it's flexor or extensor, so if they're doing tenolysis on a flexor tendon and a tenolysis on an extensor tendon; and even though they're making separate incisions, they still can only use -27681 and report it once. The lengthening or shortening of a tendon, if you notice this code, it specifically says, “through the same incision”. So if you're doing multiple tendons within the same incision, you're going to use -27686.

If you’re doing lengthening or shortening of a tendon through different incisions, you can report -27686 for each incision that you make. That's why it’s different from anything else we've looked at. You have to dive deep into the codes to verify exactly what scenario best fits to report these different kinds of codes.
The other codes that kind of do this are the fusion of arthrodesis of the tarsometatarsal joints. Now, the tarsal-metatarsal joints are the joints where the toes meet the foot. And unfortunately, 28730 are for the fusion of multiple joints. So when they say multiple, they're meaning multiple toes. And 28740 is the fusion of one joint. So if you are fusing multiple joints within the foot area, the tarsal-metatarsals, there is only one code that represents all of those.

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