How To Use CPT Code 28420

CPT 28420 describes the open treatment of a calcaneal fracture, including internal fixation, when performed, with a primary iliac or other autogenous bone graft. 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 28420?

CPT 28420 is used to describe the open treatment of a calcaneal fracture, which involves the surgical repair of a fracture in the heel bone. The procedure may include the use of internal fixation, such as screws or nails, to stabilize the fracture. Additionally, a bone graft, typically obtained from the iliac crest, may be used to aid in the healing process.

2. Official Description

The official description of CPT code 28420 is: ‘Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)’

3. Procedure

1. The provider begins by making an incision in the skin over the heel bone, exposing the fractured bone.
2. Any nonviable or dead tissue around the fracture site is removed.
3. The provider then aligns the fractured fragments back into their normal position.
4. If necessary, internal fixation implants, such as screws or metal plates, are used to hold the fracture fragments in place.
5. A separate incision is made to obtain a bone graft, typically from the iliac bone.
6. The bone graft is then used to fix the fractured bone.
7. Hemostasis is achieved at the surgical site, and the wound is closed by suturing the soft tissue layers.

4. Qualifying circumstances

CPT 28420 is performed on patients with a calcaneal fracture, also known as a heel bone fracture. The procedure may involve the use of internal fixation and a bone graft. The bone graft is typically obtained from the iliac crest or another autogenous source. It is important to note that the use of a bone graft is included in this code.

5. When to use CPT code 28420

CPT code 28420 should be used when the provider performs open treatment of a calcaneal fracture, including internal fixation, when performed, with a primary iliac or other autogenous bone graft. This code should not be used if the procedure does not involve a bone graft or if a different type of graft is used.

6. Documentation requirements

To support a claim for CPT code 28420, the provider must document the following information:

• Patient’s diagnosis of a calcaneal fracture
• Details of the procedure, including the use of internal fixation and bone graft
• Specific location of the bone graft, such as the iliac crest
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT code 28420, ensure that the procedure meets the criteria outlined in the code description. The use of internal fixation and a bone graft should be documented. It is important to note that CPT code 28420 should not be reported if the procedure does not involve a bone graft or if a different type of graft is used. Additionally, consider any applicable modifiers or additional codes that may be necessary to accurately report the procedure.

8. Historical information

CPT code 28420 was added to the Current Procedural Terminology system on January 1, 1990. The code description was updated on January 1, 2008 to include the clarification of including the obtaining of the bone graft.

9. Examples

1. A patient undergoes open treatment of a calcaneal fracture with internal fixation and a primary iliac bone graft.
2. A provider performs open treatment of a calcaneal fracture, including internal fixation and a bone graft from another autogenous source.
3. A calcaneal fracture is surgically repaired using internal fixation and a bone graft from the iliac crest.
4. A patient with a calcaneal fracture undergoes open treatment with internal fixation and a primary iliac bone graft.
5. A provider performs open treatment of a calcaneal fracture, including internal fixation and a bone graft, to aid in the healing process.
6. A calcaneal fracture is surgically repaired using internal fixation and a bone graft from an autogenous source.
7. A patient undergoes open treatment of a calcaneal fracture with internal fixation and a bone graft from the iliac crest.
8. A provider performs open treatment of a calcaneal fracture, including internal fixation and a primary autogenous bone graft.
9. A calcaneal fracture is surgically repaired using internal fixation and a bone graft from the iliac bone.
10. A patient with a calcaneal fracture undergoes open treatment with internal fixation and a bone graft from another autogenous source.