august 2014

Category III Code for Arthroereisis

Flatfoot deformity is a common condition that can be either congenital or an acquired deformity.  When you look at the inside portion of the midfoot you will notice that there is an arch in the foot.  What happens with some people is that during weight bearing (standing with pressure being put on the joint) the talus will displace anteriorly and medially in a downward motion which causes the arch to collapse.  In order to correct this condition the physician must stabilize the subtalar joint between the talus and calcaneus to prevent displacement of the talus and this accomplished by inserting an implant into the subtalar joint.  The most common types of implants are the MBA (Maxwell-Brancheau Arthroereisis) or the HyProCure Subtalar Implant.  The implant looks like a large threaded screw.  Placement of these implants is usually performed by making a small incision on the lateral side of the foot along with placement of a guide wire through the subtalar joint.  The implant is then placed over the guide wire and advanced until seated at the subtalar joint and then screwed into place.

Category III code 0335T – Extra-osseous subtalar joint implant for talotarsal stabilization – should be reported for this procedure.

I also want to make you aware of information contained in CPT Assistant regarding arthroereisis which states;

“Recently, some surgeons advocated coding the subtalar arthroereisis procedure as a treatment of a dislocation. This would be a misrepresentation of the dislocation treatment codes, as there is no anatomical evidence of a joint dislocation (ie, complete disruption of a joint) present at the subtalar joint when using this type of implant.”

Your operative report may be dictated to indicate that there is a dislocation but watch for the method of treatment and when the physician is using a subtalar joint implant that would indicate that this is an arthroereisis and not a dislocation treatment.


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