How To Use CPT Code 28406

CPT 28406 describes the percutaneous skeletal fixation of a calcaneal fracture with manipulation. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28406?

CPT 28406 is used to describe the percutaneous skeletal fixation of a calcaneal fracture with manipulation. This procedure involves the provider manipulating the fractured bone back into its original position using hardware such as pins and wires to secure the bones. It is important to note that this code does not involve an incision to expose the bone.

2. Official Description

The official description of CPT code 28406 is: ‘Percutaneous skeletal fixation of calcaneal fracture, with manipulation.’

3. Procedure

1. During the procedure, the patient is prepped and anesthetized.
2. The provider then treats the calcaneus bone fracture by aligning the displaced bone fragment(s) through manipulation, moving them into the appropriate position.
3. Pins are placed through the skin and into the bone to fix the fragment(s) in place.
4. Finally, the foot and leg are placed in a cast, brace, or splint to stabilize and protect the heel bone.

4. Qualifying circumstances

CPT 28406 is used for the treatment of a calcaneal fracture that requires manipulation and percutaneous surgery for fixation. It is important to note that this code does not involve an incision to expose the bone. For closed calcaneal fracture treatment not requiring manipulation, a different code should be used. For open calcaneal fracture treatment, with or without bone grafting, a different set of codes should be used.

5. When to use CPT code 28406

CPT code 28406 should be used when a provider performs percutaneous skeletal fixation of a calcaneal fracture with manipulation. It is important to ensure that the procedure meets the specific requirements outlined in the code description. If the procedure does not involve manipulation or requires an incision to expose the bone, a different code should be used.

6. Documentation requirements

To support a claim for CPT 28406, the provider must document the following information:

• Calcaneal fracture diagnosis
• Details of the manipulation performed
• Hardware used for fixation
• Type of immobilization applied (cast, brace, or splint)

7. Billing guidelines

When billing for CPT 28406, ensure that the procedure meets the specific requirements outlined in the code description. It is important to accurately document the details of the procedure and the necessary supporting documentation. Additionally, be aware of any bundling or unbundling guidelines that may apply to this code.

8. Historical information

CPT 28406 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A provider performs percutaneous skeletal fixation with manipulation for a calcaneal fracture in a patient involved in a car accident.
2. A patient sustains a calcaneal fracture while playing sports and undergoes percutaneous skeletal fixation with manipulation to realign the fractured bone.
3. A provider treats a calcaneal fracture in an elderly patient using percutaneous skeletal fixation with manipulation to restore proper alignment.
4. A patient with a severe calcaneal fracture undergoes percutaneous skeletal fixation with manipulation to stabilize the fractured bone and promote healing.
5. A provider performs percutaneous skeletal fixation with manipulation for a calcaneal fracture in a patient with osteoporosis.
6. A patient presents with a displaced calcaneal fracture and undergoes percutaneous skeletal fixation with manipulation to restore normal bone alignment.
7. A provider treats a calcaneal fracture in a young athlete using percutaneous skeletal fixation with manipulation to ensure proper healing and prevent long-term complications.
8. A patient sustains a calcaneal fracture in a fall and undergoes percutaneous skeletal fixation with manipulation to realign the fractured bone and promote healing.
9. A provider performs percutaneous skeletal fixation with manipulation for a complex calcaneal fracture in a patient with multiple injuries.
10. A patient with a calcaneal fracture undergoes percutaneous skeletal fixation with manipulation to restore normal foot function and reduce pain.