Coding for Plantar Plate Repair

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Advisor, APMA Coding Committee Expert Panelist, Codingline Advisor, APMA MACRA Task Force Fellow, American Academy of Podiatric Practice Management Board of Directors, American Society of Podiatric Surgeons Board of Directors, American Professional Wound Care Association Editorial Advisory Board, WOUNDS Twitter: @DrLehrman Disclaimer

CPT codes and their descriptions and the policies discussed in this webinar do not reflect or guarantee coverage or payment. Just because a CPT code exists, payment for the service it describes is not guaranteed. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. The coding advice provided in this webinar reflects only the opinions of the speaker. APMA and Jeffrey Lehrman and Lehrman Consulting, LLC do not claim responsibility for any consequences or liability attributable to the use of the information contained in this presentation Reference Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2018 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). Reference 2019 cpt Professional Anatomy of the Plantar Plate Illustration: Australasian Academy of Podiatric Sports Medicine, December 3, 2013

3 Anatomy of the Plantar Plate Illustration: Australasian Academy of Podiatric Sports Medicine, December 3, 2013

4 Plantar Plate Anatomy

• Primarily type I collagen

• Metatarsal Head   Proximal phalanx

• Insertional fibers from the lumbricals and interosseous tendons

• Distal attachments of the plantar fascia.

5 Anatomy Lesser MPJ Plantar Plate

• Proper collateral ligaments (PCL) • Accessory collateral ligaments (ACL)

• PCL = transverse plane stability

6 Plantar Plate Dysfunction

Attrition over time or frank rupture

7 Etiology of Plantar Plate Dysfunction •Short 1st metatarsal •Elevated 1st metatarsal •Long 2nd metatarsal •Long 3rd metatarsal •Rigidly contracted hammertoe •HAV

8 Hammertoe

• M20.41 Other hammer toe(s) (acquired), right foot

• M20.42 Other hammer toe(s) (acquired), left foot

9 CPT 28285

• Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

10 Hammertoe

• M20.41 Other hammertoe(s) (acquired), right foot

• M20.42 Other hammertoe(s) (acquired), left foot

11 Clawtoe

12 CPT 28285

• Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)

13 Plantar Plate Dysfunction Diagnoses

• M21.6X1 Other acquired deformities of right foot • M21.6X2 Other acquired deformities of left foot

• M24.574 Contracture, right foot • M24.575 Contracture, left foot

14 Plantar Plate Dysfunction Diagnoses

M66.371 Spontaneous rupture of flexor tendons, right ankle and foot

M66.372 Spontaneous rupture of flexor tendons, left ankle and foot

15 Plantar Plate Dysfunction Diagnoses

M24.274 Disorder of ligament, right foot

M24.275 Disorder of ligament, left foot

16 CPT Codes For Plantar Plate Repair

• What was repaired? • Ligament • Tendon • Both ligament and tendon? • Reconstructive with osseous work • Grafting involved?

17 CPT 28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

18 19 CPT 28313 Reconstruction, angular deformity of toe, soft tissue procedures only (e.g., overlapping second toe, fifth toe, curly toes)

20 True Plantar Plate Repair

CPT 28899 (unlisted foot/toe procedure)

21 CPT 28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon

22 CPT Codes For Plantar Plate Repair

CPT 28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon

+

CPT 28308 Osteotomy, with or without lengthening, shortening, or angular correction, metatarsal; other than first metatarsal, each

23 Thank You!! Coding for Plantar Plate Repair

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Advisor, APMA Coding Committee Expert Panelist, Codingline Advisor, APMA MACRA Task Force Fellow, American Academy of Podiatric Practice Management Board of Directors, American Society of Podiatric Surgeons Board of Directors, American Professional Wound Care Association Editorial Advisory Board, WOUNDS Twitter: @DrLehrman