Q:  A physician performed a fusion at the first tarsometatarsal joint and an open reduction with internal fixation of the second TMT joint. Can I report both 28740 and 28615?
A:  Yes, it would be appropriate to report both codes. They are being done at separate sites. The first procedure is a fusion at the first TMT and the second procedure is an ORIF of the second TMT.

Q:  What CPT code would be appropriate for repair of an osteochondritis dissecans lesion of the talar dome using an allograft?
A:  Unfortunately, there is not a CPT code that describes the procedure using allograft. The only option available is 28446 but that is with autograft so we cannot use it. This would be reported using an unlisted code (27899)

Q:  If a surgeon does a reconstruction of both the anterior tibiofibular ligament and the calcaneofibular ligament, would we report two units of ligament repair?
A:  No, CPT 27698 includes the repair of both the ATFL and the CFL so you would only report the code once.

10/14/22 Q: The Brostrom procedure and CPT assist that is noted in the webinar, it mentions that a “tissue is required” for secondary repair. For Brostrom procedure this does not always require another tissue or graft. Is Brostrom procedure considered secondary as long as the documentation is “chronic” or “ankle instability”?
A:  Usually, you will see another tissue or graft used, but this is not required (per the CPT code descriptor). Here are the definitions defined by the APMA:

  • Primary vs. Secondary
  • Primary repair: Any repair of an acute injury completed within the first 24 hours after the injury.
  • Delayed primary repair: A repair performed within 24 hours to two weeks of the injury.
  • Secondary repair: A repair performed after two weeks of injury.
Mary Bort, CPC, CPMA, CANPC, CASCC, COSC

Mary Bort, CPC, CPMA, CANPC, CASCC, COSC

Consultant

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.

3 Comments

  1. Lynn Handy

    When performing a total ankle arthroplasty, is it possible to code for a tibial prophylactic nail insertion due to poor bone quality? (27702, 27745)

    Reply
    • kkluglein

      Hi Lynn,

      This one is tough to answer without seeing the documentation. Per the CCI edits, those two CPT codes do bundle however a modifier is allowed.

      We recommend reviewing the documentation to make sure it supports it.

      Reply
  2. Nanci Storves

    Very Good

    Reply

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