Know What Structures Make up the Lisfranc Joint Complex
Question: A 40-year-old patient was referred to our podiatry practice after they missed the last step of their staircase a few days ago and reported landing awkwardly on their right foot. The patient heard a pop and developed substantial swelling within a few hours with pain concentrated over the first and second tarsometatarsal joints. The podiatrist performed a physical examination and ordered bilateral weight-bearing dorsoplantar/anteroposterior (AP), medial oblique, and lateral X-ray views. After reviewing the X-rays, the podiatrist ordered a CT scan of the right foot without contrast to define fracture involvement and aid in surgical planning. The documented assessment lists closed right Lisfranc fracture-dislocation. How should I report the diagnosis? Nevada Subscriber Answer: A Lisfranc injury is one that occurs in the midfoot. The bones may become broken (fractured) or the ligaments supporting the midfoot are torn. The Lisfranc joint complex is where the tarsals (middle bones of the foot) connect to the long bones that lead to the toes (metatarsals). This joint is referred to as the tarsometatarsal joint. In your case, the podiatrist documented a dislocation of the patient’s Lisfranc joint complex in the right foot. However, Lisfranc is not a term that is listed in the ICD-10-CM Alphabetic Index. Instead, you’ll follow the path of Dislocation > foot > tarsometatarsal joint to arrive at the correct code subcategory. Turn to the Tabular List to verify the code. Assign S93.321A (Subluxation of tarsometatarsal joint of right foot, initial encounter) to report the Lisfranc dislocation of the right foot. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
