Orthopedic Coding Alert

Question: In a patient diagnosed with Lisfranc injury in the left foot, the following procedures were done:

1. ORIF of right foot Lisfranc injury and fracture;
2. ORIF of first tarsometarsal joint;
3. Closed reduction and perc pinning of third tarsometatarsal joint; and
4. Removal of pins x 3 through separate incisions.

How do we report these procedures?

Alaska Subscriber

Answer: Lisfranc injury is the displacement of one or more metatarsals from the tarsus, often accompanied by a fracture of the base on one of the metatarsals, usually the second. When reporting Lisfranc repair, you need to report repair of each metatarsal bone or tarsometatarsal joint as one unit.

For ORIF of the first tarsometatarsal joint, you report code 28615 (Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed). It isn’t clear if the surgeon repaired the 2nd tarsometatarsal joint, metatarsal joint, or both.

So, for open repair and internal fixation of fracture(s) in the Lisfranc area, you may report code 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each). You report one unit or 28485 for each metatarsal fracture and append modifier 59 (Distinct procedural service) for the repair of the second metatarsal bone fracture.

For the closed reduction and pinning in the third metatarsal joint, you report code 28606 (Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation). You do not separately report pin removal as this is inclusive in 28606.