Podiatry Coding & Billing Alert

Hint: Report 27650 for primary Achilles rupture repair without graft.

When your podiatrist performs a repair for a ruptured Achilles tendon, you must always check the medical documentation for numerous details including whether the repair was primary or secondary. You must also know whether your podiatrist used a graft or not during the repair.

Read on to learn more.

Podiatrist Doesn’t Use Graft for Primary Achilles Repair? Do This

When your podiatrist performs a primary Achilles repair, you must first check the medical documentation to see if he used a graft or not because this information will impact your CPT^® code choice.

Without graft: If your podiatrist performs a primary Achilles repair without a graft, you should report 27650 (Repair, primary, open or percutaneous, ruptured Achilles tendon). According to 27650’s code descriptor, you can report this code if the repair is either open or percutaneous.

For this type of the scenario, the patient usually has an acute Achilles tear, and he will present with sudden lower extremity pain, usually around the ankle or calf. Oftentimes, the patient will sustain this type of Achilles tear while playing a sport or other high-impact activity. However, sometimes the tendon can rupture spontaneously with no specific injury.

Documentation check-up: When you report 27650 on your claim, you must make sure that your podiatrist’s documentation specifies whether the tear was due to an injury or to a spontaneous rupture. You should also append modifiers LT (Left side) or RT (Right side) accordingly.

Coding example: The patient comes in with extreme pain and swelling of her left heel. She was playing basketball and landed wrong on her foot. She reported hearing a popping sound after the injury occurred. The podiatrist performed an exam and MRI to diagnose the patient with a ruptured Achilles tendon. Since the podiatrist determined the injury as an acute Achilles tear, he chose not to use a graft during this primary repair. You should report 27650 with the LT modifier appended on your claim. For the ICD-10-CM code, you will report S86.012A (Strain of left Achilles tendon, initial encounter).

Turn to This Code if Podiatrist Uses Graft for Repair

On the other hand, if your podiatrist performs a primary Achilles repair and uses a graft, you will report code 27652 (Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)). Your podiatrist will typically perform this type of repair for a more complicated Achilles rupture.

According to 27652’s code descriptor, you can report this code if the primary repair is either open or percutaneous.

The podiatrist’s notes should make it clear that he used a graft during the Achilles repair. If your podiatrist says that he used “various flaps sutured or woven to the ruptured site,” this is a likely indication that he used a graft for the repair.

Don’t miss: You should not separately report the harvesting of the tendon graft, if performed, because this is an included service.

Coding example: Check out this coding example from Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan: The podiatrist takes the patient into surgery after diagnosing an Achilles tendon rupture of the right heel. The podiatrist’s initial thought is to perform a percutaneous repair, but he is not able approximate the edges. So, he converts the procedure to an open procedure and uses a graft to supply length to make the repair and allow for proper positioning of the foot. In this scenario, you would report 27652 with modifier RT appended and S86.011A (Strain of right Achilles tendon, initial encounter) on your claim.

Rely on This Code for Secondary Achilles Repair

If your podiatrist performs a secondary Achilles repair instead of a primary repair, you should report code 27654 (Repair, secondary, Achilles tendon, with or without graft). You will most likely encounter this scenario when the patient has an old tear or has re-torn a previous repair and has major retraction or tendon scarring.

Documentation check-up: Make sure in his medical documentation your podiatrist states why he is performing the secondary repair. He must also state whether he used a graft or not, although, according to 27654’s code descriptor, this code is applicate with or without a graft.

Keep Eye Out for These Achilles Rupture Symptoms

When a patient has an Achilles rupture, he will experience pain and swelling at or near his heel. If he tries to stretch, bend forward, or rise on his tiptoes, he will feel pain. When the rupture occurs, patients may also hear a popping sound.

Your podiatrist will diagnose an Achilles rupture when he performs the physical exam and by using X-rays or magnetic resonance imaging (MRI).