Wiki Tarsometatarsal Joint - Intermediate or Small?

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emily.verbaere@gmail.com

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My coding team and I are going back and forth on whether the tarsometatarsal joint is classified as intermediate or small. One of our providers says it's intermediate.

Does anyone have a list, from a credible source, that classifies the joints into small, intermediate, and major?
 
The majority consensus in Podiatry is that the joints between the tarsal bones: ankle, talocalcaneonavicular, cuneonavicular, cuboideonavicular, subtalar, talo-navicular, intercuneiform and calcaneocuboid joints (I may have repeated joints) are all intermediate, any joints distal to those would be considered small joints. With that said, there are no official lists that I am aware of.
 
I have never been able to find a reputable, definitive source to use for every single joint. We considered them intermediate as Tonia stated above.
 
emily.verbaere@gmail.com said:
I appreciate everyone's feedback. The document that was shared above is from the AMA and it states that for coding purposes the tarsometatarsal joint is considered small.
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That is not from the AMA. It is from Codify by AAPC. The AMA info on the bottom is just showing the trademark for CPT/AMA. The article is quoting two individuals opinions. To me, that is still not a definitive, reputable source. I'm not saying they are wrong, just that it is not an "official" source. That would be like me telling a doctor the definitive reason for coding a certain way is, "Because I said so." with no backup. The article even says, "Best bet: If you're unsure about the "size" of a joint or bursa, check with the provider to zero in on the correct measurement."

There is an AMA CPT® Knowledge Base article (10/26/17) and CPT Assistant (8/2017) which indicates to use 20600 for a right first CMC w/o US. They explain the CMC is considered a small joint. However, I have not been able to find anything from either of those specifically for the TMT. Could we mirror the two for an answer? Maybe.

There is a "Z-Health publishing" article which specifically asks this question but I don't have access to the answer and I am not sure how "official" that is either. https://www.zhealthpublishing.com/zquestions/view/6157

If it were me, I may go with the 1-5 TMT are small but when we move into cuneiforms, subtalar, calcaneocuboid, talonavicular, etc. they are intermediate. (Like Tonia indicated above). Although it could still be argued otherwise since the it's where the MT connect to the cuneiforms and cuboid. If the provider feels strongly to bill intermediate, it's ultimately up to them. I still can't decide 100%.

This is another thought on it: https://www.podiatrym.com/search3.cfm?id=29136
 
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