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Closed treatment of a calcaneal fracture involves a non-surgical approach to address a fracture of the calcaneus, which is the largest bone in the foot and forms the heel. This procedure is indicated when the fracture is displaced, meaning that the bone fragments are not aligned properly. The treatment begins with obtaining separate radiographs to confirm the presence of the fracture and to assess its displacement. A thorough neurovascular examination is conducted to ensure that the nerves and blood vessels surrounding the injury are intact and functioning properly. In cases where the fracture is nondisplaced or minimally displaced, as described in CPT® Code 28400, no manipulation is necessary, and the fracture is treated with immobilization using a cast or brace. However, for CPT® Code 28405, which pertains to displaced fractures, the procedure includes the manual reduction of the fracture fragments to restore proper anatomical alignment. Following this manipulation, additional radiographs are obtained to verify that the alignment has been successfully achieved. Finally, a cast or brace is applied to immobilize the fracture, promoting healing and stability during the recovery process.
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The closed treatment of a calcaneal fracture with manipulation is indicated for patients presenting with a displaced fracture of the calcaneus. This type of fracture may occur due to trauma, such as falls or accidents, leading to misalignment of the bone fragments. The procedure is performed to restore proper anatomical alignment and ensure optimal healing.
The procedure begins with the patient being positioned appropriately to allow access to the affected heel. The physician first conducts a thorough neurovascular examination to assess the integrity of the nerves and blood vessels in the area surrounding the fracture. Following this assessment, separate radiographs are obtained to confirm the presence of the calcaneal fracture and to evaluate the degree of displacement. Once the fracture is confirmed, the physician proceeds with the manipulation of the displaced fracture fragments. This involves manually adjusting the bone fragments back into their proper anatomical position. The physician carefully applies pressure and uses specific techniques to ensure that the fragments are aligned correctly. After achieving the desired alignment, additional radiographs are taken to verify that the manipulation has been successful and that the fracture is properly reduced. Once confirmed, a cast or brace is applied to immobilize the fracture, providing stability and support during the healing process.
After the closed treatment procedure, the patient is monitored for any signs of complications, such as increased pain, swelling, or neurovascular compromise. The cast or brace is typically kept in place for a specified duration to ensure proper immobilization of the fracture. Patients are advised on post-procedure care, which may include instructions on weight-bearing activities, pain management, and follow-up appointments for further evaluation and radiographic assessment of healing. It is essential for patients to adhere to the prescribed care plan to promote optimal recovery and prevent any potential complications.
| Short Descr | TREATMENT OF HEEL FRACTURE | Medium Descr | CLOSED TX CALCANEAL FRACTURE W/MANIPULATION | Long Descr | Closed treatment of calcaneal fracture; with manipulation | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Multiple Reduction Applies | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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