​For many years I struggled coding foot and ankle procedures.

I would ask myself:

“Is this tendon a flexor or is it an extensor?”

“Hmm... what does it do?”

 “Is this a ligament or is this a tendon?”   

Of course, back then we didn’t have internet and had to utilize other resources. This usually meant going to the physician and asking because we didn’t have the abundance of resources like we do today. Thank goodness for technology!

Foot and ankle cases can be quite complex at times and usually, several resources are needed to help determine whether the CPT codes are bundled. When coding foot and ankle procedures, I find it necessary to use my Encoder, the National Correct Coding Initiative (NCCI), and the AAOS Global Data guide (American Academy of Orthopedic Surgeons). All three play a key role in putting the pieces of the puzzle together. It also helps to have some good-quality pictures to refer to.

What do you do when the AAOS indicates a specific procedure code is included in the primary procedure performed, but the NCCI edits does not bundle them?

It’s critical to understand the procedure and be able to sort out which set of rules your practice is going to follow on a regular basis. As you already know, it would not be appropriate to use one set of rules for one patient and then a different set for the next. 

Remember, you should always be consistent in your reporting!




Mary is a consultant for The Haugen Consulting Group with over 25 years of health care industry experience. She started her career in Orthopedics which was her passion for decades. In addition to Orthopedics, she provides expertise in other specialties such as Anesthesia, Ambulatory Surgery Center, as well as most surgical specialties . She has experience working the professional fee side of coding, audit, education as well as compliance, serving both coders and physicians, as well as the surgical side. She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Anesthesia Professional Coder (CANPC) Certified Ambulatory Surgery Center Coder (CASCC) and Certified Orthopedic Surgery Coder (COSC).

During her free time, she loves to do crafts, enjoys the outdoors, and the Broncos! She has 4 daughters, and 10 grandchildren which light up her life.

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