Revenue Cycle Insider

Method is key to correctly coding these Achilles procedures.

When a patient experiences an injury to their Achilles tendon, the discomfort is typically instant and relentless. The process of coding Achilles tendon imaging services, however, doesn’t have to be painful.

We’ll make this process painless for you with this review of the differences between Achilles imaging code options. We’ll conclude by solidifying your understanding with two case studies.

Understand the Condition

Injuries to the Achilles tendon can vary from severe, like those involving a partial or complete tear or rupture of the Achilles tendon, to less severe ones like a sprain or overextension of the Achilles.

Severe injuries are normally due to sudden forces or stress on the tendon and typically require surgical intervention. If a patient experiences an Achilles rupture, they will have symptoms of pain and swelling at or near the heel, and may even hear a popping sound when the injury first occurs.

The practitioner will diagnose an Achilles tendon injury by performing a physical exam and through the use of MRI or ultrasound (US) imaging.

While the practitioner may also decide to conduct an X-ray to eliminate the possibility of a fracture or dislocation, the MRI and US will ultimately lead to the diagnosis of the Achilles injury.

Know Your Coding Options

When your provider performs a US for Achilles tendon injuries, you’ll likely turn to one of the following codes:

• 20606 (Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting)
• 76881 (Ultrasound, complete joint (ie, joint space and peri-articular soft-tissue structures), real-time with image documentation)
• 76882 (Ultrasound, limited, joint or focal evaluation of other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation)

For MRI coding, you’ll look at the following codes:

• 73718 (Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s))
• 73719 (… with contrast material(s))
• 73720 (… without contrast material(s), followed by contrast material(s) and further sequences)
• 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material)
• 73722 (… with contrast material(s))
• 73723 (… without contrast material(s), followed by contrast material(s) and further sequences)

Make note: Append modifier LT (Left side) or RT (Right side) to your MRI or US codes to indicate laterality to the payer.

Test Your Skills

Scenario 1: The patient was brought to the operating table and laid in a prone position. Their right Achilles tendon was identified using US. Their skin was cleaned in the usual sterile fashion using Betadine and alcohol. Under US guidance, a 22-gauge needle was inserted below the Achilles tendon and after negative aspiration of blood, 10 cc of 1 percent lidocaine was injected above the fat pad and below the Achilles tendon, hydro-dissecting the two layers. The patient tolerated the procedure well and there were zero complications. A wrapping was then applied. The patient noted an immediate improvement in the pain after the procedure. The practitioner’s diagnosis was M76.61 (Achilles tendinitis, right leg) for this patient.

Which CPT^® code(s) should you report for this procedure?

Answer: Because the practitioner doesn’t specify that the tendon was directly injected, you should report 20606. However, if the tendon had been directly injected without the use of US, you would then report 20551 (Injection(s); single tendon origin/insertion). You should also append modifier RT to 20606 to indicate laterality.

Make note: According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, CGSC, COPC, COSC, CEO of Healthcare Inspired, LLC, you can also report 76942 (Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation) with 20551 if you have medical documentation to justify the guidance, but it would be far less typical than to simply code 20606.

Scenario 2: The practitioner’s notes indicate that a patient who had ruptured their right Achilles tendon a year ago ruptured the tendon a second time. After an MRI with contrast materials confirmed the extent of the damage to the tendon and the spontaneous rupture’s location, the surgeon decides to perform surgery to attempt to repair the damage. The surgeon makes an incision over the back of the ankle, in line with the Achilles tendon. They then dissect away scar tissue and expose the damaged tendon, while at the same time removing any degenerative tissue. The surgeon then sutures the ruptured ends of the Achilles together using the Bucknell technique. The surgeon also reinforces the repair with synthetic grafts. The wound is then irrigated and closed using staples.

How should you report this encounter?

Answer: Because this is a secondary repair to the Achilles, you should report:

• 27654 (Repair, secondary, Achilles tendon, with or without graft)
• 73719
• Modifier RT appended to 27654 to and 73719 to indicate laterality
• M66.871 (Spontaneous rupture of other tendons, right ankle and foot) appended to 27654 and 73719 to represent the patient’s injury.

 Lindsey Bush, BA, MA, CPC, Production Editor, AAPC