Query: LisFranc Fracture/Dislocation
A patient sustained a LisFranc
fracture/dislocation of the 1st through 5th
metatarsals (Hardcastle Type A). There was a
lateral dislocation at the 1st metatarsal-
cuneiform joint and at the 5th metatarsal-cuboid
joint with displaced fractures through the bases
of metatarsals 2-3-4.
Two dorsal incisions were performed to allow
open reduction internal fixation procedures
using cannulated screws through the 1st
metatarsal-cuneiform, medial cuneiform-second
metatarsal, as well as screws across the 4th and
5th metatarsals into the cuboid. How would one
code this?
Ralph C. Napoli, DPM
Emerson, N.J.
Codingline Response: Since this represents
different fractures of the metatarsals, I would
code this using CPT 28615 (open treatment of
tarsometatarsal joint dislocation, with or
without internal or external fixation) for the
1st and 5th metatarsal fractures. I would then
use CPT 28485 (open treatment of metatarsal
fracture, without or without internal or
external fixation, each) for 2, 3 and 4.
CPT 28615
CPT 28615-59
CPT 28485-59
CPT 28485-59
CPT 28485-59
A copy of the operative note along with a letter
of explanation may be helpful in getting this
claim paid correctly.
Denise Paige, CPC
Long Beach, CA
