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Question: The podiatrist performed a subtalar joint fusion with rigid internal fixation, a medial calcaneal displacement osteotomy with rigid internal fixation, and an Achilles tendon lengthening and a cotton osteotomy all on the same foot.

The codes for the procedures are 28725, 28300, 28304, and 27685. The payer states that 28300, 28304, and 27685 are all included in 28725, but it seems that additional work is involved.

How would you recommend billing the procedures?

California Subscriber

Answer: You鈥檒l assign 28725 (Arthrodesis; subtalar) to report the subtalar joint fusion. The National Correct Coding Initiative (NCCI) edits bundle 28300 (Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation) and 28304 (Osteotomy, tarsal bones, other than calcaneus or talus) into 28725. This means that since 28300 and 28304 are inherently included in 28725, you won鈥檛 bill the codes separately.

Code 27685 (Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)) is not bundled into 28725, according to the NCCI edit pairs. Therefore, you may bill 27685 separately from 28725. You should also append modifier 59 (Distinct procedural service) to 28725 to indicate to the payer that the subtalar joint fusion was performed separately from the Achilles tendon lengthening.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC