Orthopedic Coding Alert

Here are three tips for reporting Lisfranc injuries.

The sun is out. People are on the sidewalks again. But an active population brings with it a slew of summer injuries. Since cycling has become more popular than ever, here is a list of common cycling injuries and how to code for them.

Negotiate Knee Problem Codes

It’s no surprise that one of the leading areas of pain affecting cyclists is the knee. From simple pain to more complicated problems requiring surgery, a good coder anticipates the following ailments.

Chondromalacia of the patella: Also known as “Runner’s Knee,” this is a condition where cartilage under the surface of the kneecap deteriorates. For this condition, you would report:

• M22.40 (Chondromalacia patellae, unspecified knee)
• M22.41 (Chondromalacia patella, right knee)
• M22.42 (Chondromalacia patellae, left knee).

Although common among athletes, rarer cases can require realignment surgery. In these cases an arthroscopic procedure can be performed to clean up the frayed cartilage. To code for the arthroscopy, use 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]).

In cases where the knee needs to be realigned and a high tibial osteotomy is performed, use code 29873 (Arthroscopy, knee, surgical; with lateral release) or, in cases when an open lateral release must be performed, use code 27425 (Lateral retinacular release, open). If the osteotomy needs to be performed on both knees, use the bilateral procedure modifier 50.

Plica Syndrome: With overuse, the knee joint can become inflamed. “Plica is not really tissue around the knee. It’s a thickening of the joint capsule and/or synovium,” says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. “This is really inside the knee.” For this condition, you would report:

• M67.50 (Plica syndrome, unspecified knee)
• M67.51 (Plica syndrome, right knee)
• M67.52 (Plica syndrome, left knee).

When nonsurgical treatments fail, most providers will again recommend the arthroscopy. Be careful in this case since not all arthroscopies are the same. For Plica Syndrome, some of the tissue is removed in a process called synovectomy. For this you would use, 29875 (Arthroscopy, knee, surgical; synovectomy, limited [e.g., plica or shelf resection] [separate procedure]).

Here’s How to Handle Common Hip Problems

The hips are imperative for balance and core strength. It’s no wonder why cyclists often suffer from hip problems after biking for long periods of time. Keep your eyes open for these ailments so you can be ready to code for them when cyclists come in to get treated.

Labral Tears: Often caused by a dislocation or overuse, labral tears can be painful for cyclists. When a labrum tears, the loose pieces can cause irritation in the hip and groin area. For injury related conditions,, you would report S73.19- (Other sprain of hip…) or, if degenerative or not injury related, you would report M24.15- (Other articular cartilage disorders, hip…), says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey.  

A provider may recommend another arthroscopy. However, this arthroscopy is particular to a labral tear, where an orthopedic surgeon performs surgical arthroscopy of a hip with the intention of repairing the labrum. In this case, use the code 29916 (Arthroscopy, hip, surgical; with labral repair).

Femoroacetabular Impingement: A common condition among athletes of any sport, femoroacetabular Impingement is a condition in which extra bone growth (called spurs) aggravates the hip socket, causing extreme discomfort during sporting events. For this condition, you do not have a specific ICD-10 code. However, most payers will recommend that you use one of the following codes:

• M25.851 (Other specified joint disorders, right hip)
• M25.852 (Other specified joint disorders, left hip)
• M25.859 (Other specified joint disorders, unspecified hip)
• M25.551 (Pain in right hip)
• M25.552 (Pain in left hip)
• M25.559 (Pain in unspecified hip).

Since the hip joint needs a smooth surface to operate without pain, most physicians will recommend another arthroscopy that is specific to femoroacetabular impingement. A femoroplasty is necessary to smooth the surface of the bone in order to remove spurs and decrease pain. The code 29914 (Arthroscopy, hip, surgical; with femoroplasty [ie, treatment of cam lesion]) includes this procedure and is an appropriate code to use for Femoroacetabular Impingements.

Fix Foot Problem Coding Before You Make Mistakes

So much pressure rests on the foot as cyclists pedal toward their destinations. It’s not uncommon to see these following foot injuries, so be ready to code for them.

Achilles tendon rupture: Also common among runners, the Achilles Tendon can rupture when cyclists put too much strenuous pressure on it. Almost all the time, this rupture leads to surgery. For this condition, you would report:

• S86.011A (Strain of right Achilles tendon, initial encounter)
• S86.012A (Strain of left Achilles tendon, initial encounter)
• S86.019A (Strain of unspecified Achilles tendon, initial encounter)

The important codes to keep in mind are 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon) or (if a graft is used) 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft [includes obtaining graft]).

If the cyclist comes in for routine postop aftercare in the office setting, report the code you used above (S86.012D) but with a “D” seventh character, which represents “subsequent encounter.” However, if the patient suffers a spontaneous rupture after the tendon repair and requires revision surgery, use code M66.87 (Spontaneous rupture of other tendons, ankle and foot), Stout says. Attach this to 27654 (Repair, secondary, Achilles tendon, with or without graft) to indicate multiple surgeries. Notice that this code is not concerned about whether or not a graft was used.

Lisfranc Injury: Lisfranc fracture can occur if a cyclist is in a crash. For sublaxion of dislocation of the TMT joint, you would report S93.32- (Subluxation and dislocation of tarsometatarsal joint). Remember, you need seven characters to complete this code. You will need to specify which metatarsal bone (5th character), whether the fracture is displaced or nondisplaced (6th character), and the encounter seventh digit (such as, “A” for initial encounter).

More serious injuries require surgery and to code for this, use 28615 (Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed). Keep in mind that this code includes an internal fixation, meaning that the orthopedic surgeon may use tools such as plates or screws to aid in the healing process.

Here are a few tips to keep in mind when coding for closed treatment of Lisfranc injuries:

• Anesthesia can be used during these surgeries but they complicate the coding.
• If the surgeon fixes the dislocation without anesthesia, use code 28600 (Closed treatment of tarsometatarsal joint dislocation; without anesthesia).
• If they do use anesthesia, use code use 28605 (Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia).