Purpose of this Petition

We need to help the APMA go to bat for us on the proper use of billing code 28585, “open treatment, talotarsal joint dislocation, with internal fixation, when performed.” We believe 28585 is the most accurate billing code to use in conjunction with the HyProCure procedure. The APMA has requested that we gather physician support for our cause and we need your help.

As you know, proper billing and coding is essential to the continued success of our podiatric practices and an endorsement from APMA on the use of a code is important for widespread acceptance. Of course, our primary purpose is to effectively and efficiently rid patients of what ails them and we need to provide our patients with treatment options that make the most sense to them. When a procedure is not covered due to incorrect coding issues, our patients are less likely to choose that option, even when it has the best overall outcomes.

Please sign the petition and also email your colleagues to do so as well. Your endorsement will be sent via email to Mr. Scott Haag, JD, MSPH, Director, Center for Professional Advocacy & Health Policy & Practice. The more signatures, the better equipped Mr. Haag will be to gain endorsement for the use of this code with HyProCure.

Support for our Position

We believe there are a few mistaken arguments that have led to opposition to the use of 28585 for HyProCure that can easily be overcome with proper understanding.

First, there may be a misconception of the primary focus, indications, and diagnosis for the use of HyProCure. Though many secondary pathologies may be corrected due to performing extra-osseous talotarsal stabilization with HyProCure, the focus and primary diagnosis of the procedure is to properly realign and stabilize the talus of the tarsal mechanism, thereby restoring the talotarsal joint and talotarsal mechanism to normal function and triplane motion.

A second concern may come from an overly narrow interpretation of the term dislocation. Dislocation is a generic umbrella term meaning the displacement (incomplete or complete) of one body part from another. This is a pathologic condition that can occur with or without trauma. The indications for HyProCure match the definition of dislocation. Displacement of the talus on the tarsal mechanism results in an altered axis therefore placing excessive abnormal strain on the calcaneus and navicular as well as the supporting soft tissues (tendons & ligaments). This is the exact condition that HyProCure corrects. There is only one code for talotarsal joint dislocation and it does not differentiate complete (acute) and incomplete (chronic/partial) dislocation. By contrast, there are separate codes for the shoulder for acute and chronic conditions, per the AMA’s CPT 2011 Professional Edition. Therefore, by extension the term as used in 28585 must cover both.

Furthermore, EOTTS with HyProCure clearly fits the description of internal fixation. In fact, HyProCure is classified with the FDA as an internal fixation device, not as an arthroereisis plug.

HyProCure is the only true EOTTS device. Other sinus tarsi devices act as an extension of the lateral process of the talus and function to block motion abruptly. HyProCure’s design and function are completely unique and different from those arthroereisis devices. HyProCure is placed deeper into the sinus tarsi. It counteracts the dislocation by stabilizing the talus at the cruciate pivot point. The talus glides over HyProCure, restoring normal triplane motion.

Summary

HyProCure is not arthroereisis or arthrodesis. HyProCure = EOTTS = 28585. It’s that simple. We need the support of the APMA to go to bat for us to ensure coverage of this procedure with HyProCure so that you can get reimbursed for helping your patients get better. Please sign the petition and also email your colleagues to do so as well.

Thanks for your support.