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Charlene Posted Tue 10th of March, 2015 09:35:18 AM

Patient had multiple traumatic lower leg & foot injury from a boat propeller. There was an open ankle capsule w/o tendon injury at this site. I used an unlisted code and insurance denied saying there was a more specific code for the service. What would be the CPT?

They also denied complex repair of a 20 cm laceration further up the leg say it was included.

SuperCoder Answered Wed 11th of March, 2015 04:18:03 AM

Hi Charlene,

As the above provided procedure documentation is not sufficient to provide accurate CPT code so please provide the procedure performed in detail so that we can provide you the CPT code.


Charlene Posted Wed 11th of March, 2015 08:59:46 AM

Open arthrotomy of cuboid bone is repaired 2-0 Ethibond sutures.

My mistake, the four peroneal tendons were also repaired (28208 x 4) within the same wound.

Would the joint capsule be incidental to the tendon repair?

SuperCoder Answered Thu 12th of March, 2015 02:58:18 AM

Hi Charlene,

I am assuming that there is a fracture on cuboid bone and provider done open reduction and internal fixation of the cuboid bone with 2-0 Ethibond sutures along with capsular repair during closure of the joint, which is considered to be part of the main procedure. In that case, the CPT code 28465 (Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, each) should be used.

Hope it Helps,

Charlene Posted Fri 13th of March, 2015 09:21:26 AM

There was not a fracture, only the joint was opened. There were 4 tendons repaired within this wound also.

SuperCoder Answered Mon 16th of March, 2015 02:44:34 AM

As the location for the both the procedures are different in terms of tendon and capsular repair then it should not be considered as incidental procedure. we have no separate code for the capsular repair procedure, in this case we can use unlisted CPT code 28899.

If there is no fracture only the tendons were repaired within the wound then we can code

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