Lisfranc dislocation -28615

ddupps

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Do you code 28615 open treatment of tarsometatarsal joint dislocation per joint that is reduced or 1 time no matter how many joints are reduced?
 

thythaot

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Hi ,
I agree with mbort, this is for more information about this. I hope it might help.
Based on December 2003 Bulletin by Margie Scally Vaught CPC, CCS-P, MCS-P reviewd by Walter J. Pedowitz, MD. said:
The mechanism of the injury causes the tarsal bones to dislocate with or without resulting metatarsal (MT) fractures. Many times, both the dislocation and the fracture are treated separately with stabilization devices, which can be closed, percutaneous or open. Separately coding for the fixation of the metatarsal fractures could depend on the location of those fractures. Lisfranc dislocation can be for one or many of the tarsometatarsal joints. The open reduction code is for each joint that is reduced in an open fashion. Here are some example
Tarsometatarsal dislocation of the right midfoot along with mid-shaft fractures of the 2nd, 3rd and 4th MTs: The dislocation is treated by open reduction internal fixation (ORIF). The MT fractures are also treated by ORIF by separate incisions. CPT code 28615 would be reported for the fixation of the dislocation. CPT code 28485-59 would be reported three times to represent each metatarsal fracture, per CPT description of the code. Modifier T, per CPT, would not be appropriate for these metatarsal shaft fractures. :)
 
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Coding both 28485 and 28615, I have had two instances now where UHC only pays for one of each service regardless of how many joints are dislocated. I do not know what I am doing wrong?
 

mbort

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be sure you are appending the -59 modifier to the line items subsequent to the 1st one. If you are already doing this, I would definitely appeal with the op note showing the different joints highlighted for them.
 
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