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The calcaneus, commonly known as the heel bone, is the largest of the tarsal bones in the foot and plays a crucial role in weight-bearing and movement. It articulates with the cuboid bone in the front and the talus bone above, forming essential joints that facilitate foot mobility. A fracture of the calcaneus typically occurs due to significant trauma, such as a fall from a height or a motor vehicle accident, which exerts a high-impact force on the heel. These fractures can lead to complications, including damage to the subtalar joint, which may restrict the foot's ability to perform inward (inversion) and outward (eversion) movements. The open treatment of a calcaneal fracture involves a surgical procedure where an L-shaped incision is made on the posterolateral aspect of the foot, allowing access to the fracture site. During the surgery, the subtalar joint is inspected, and the fracture is reduced using bone elevators. To maintain the reduction, temporary wire fixation is applied, and the alignment is confirmed through radiographic imaging. If necessary, internal fixation devices such as screws or plates are utilized to stabilize the fracture. In cases where an autogenous bone graft is required, a graft is harvested from the iliac crest or another donor site and is packed into the fracture area before securing the fixation device. This comprehensive approach ensures proper healing and restoration of function in the calcaneus.
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The open treatment of calcaneal fractures is indicated for patients who have sustained a fracture of the calcaneus due to high-impact trauma. The following conditions warrant this surgical intervention:
The procedure for the open treatment of a calcaneal fracture involves several critical steps to ensure proper healing and stabilization of the bone. The following outlines the procedural steps:
Post-procedure care for patients who have undergone open treatment of a calcaneal fracture includes monitoring for complications, managing pain, and facilitating recovery. Patients are typically advised to keep the affected foot elevated to reduce swelling and to follow specific weight-bearing restrictions as directed by the surgeon. Rehabilitation may involve physical therapy to restore mobility and strength in the foot and ankle. Follow-up appointments are essential to assess healing through radiographic imaging and to ensure that the fixation remains stable. Any signs of infection or complications should be reported to the healthcare provider promptly.
| Short Descr | TREAT/GRAFT HEEL FRACTURE | Medium Descr | OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT | Long Descr | Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | 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. | 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). | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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) |
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| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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