How To Use CPT Code 28122

CPT 28122 refers to a partial excision of the tarsal or metatarsal bone, excluding the talus or calcaneus, for conditions such as osteomyelitis or bossing. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 28122 procedures.

1. What is CPT 28122?

CPT 28122 is a medical procedure code used to describe the partial excision of the tarsal or metatarsal bone, excluding the talus or calcaneus, in cases of osteomyelitis or bossing. This code is used by medical professionals to accurately document and bill for this specific procedure.

2. 28122 CPT code description

The official description of CPT code 28122 is: “Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus.”

3. Procedure

The 28122 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision on the anterior aspect of the foot.
3. Soft tissues and tendons are dissected, and the infected bone of the tarsal or metatarsal region is identified.
4. The infected portion of the bone is partially excised in a crater-like fashion, leaving a small saucer-like depression in the bone. Alternatively, a portion of the shaft of the long bone may be excised.
5. The provider may fill the cavity left in the bone using a bone graft.
6. The wound is closed in layers.

4. Qualifying circumstances

Patients eligible to receive CPT code 28122 services are those diagnosed with osteomyelitis or bossing affecting the tarsal or metatarsal bones, excluding the talus or calcaneus. The procedure is typically performed when conservative treatments have failed, and the infection or deformity is causing significant pain, discomfort, or functional limitations.

5. When to use CPT code 28122

It is appropriate to bill the 28122 CPT code when the provider has performed a partial excision of the tarsal or metatarsal bone, excluding the talus or calcaneus, for conditions such as osteomyelitis or bossing. The code should be used only when the procedure meets the specific criteria outlined in the CPT code description and when the patient’s medical condition warrants this type of intervention.

6. Documentation requirements

To support a claim for CPT 28122, the following information should be documented:

• Patient’s medical history and diagnosis, including the presence of osteomyelitis or bossing affecting the tarsal or metatarsal bones.
• Conservative treatments attempted and their outcomes.
• Indications for the procedure, such as pain, discomfort, or functional limitations.
• A detailed description of the procedure performed, including the specific bone(s) involved and the technique used (craterization, saucerization, sequestrectomy, or diaphysectomy).
• Any intraoperative findings or complications.
• Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 28122, it is essential to follow the specific guidelines and rules set forth by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). These guidelines include accurate documentation of the procedure, proper use of modifiers when applicable, and adherence to any payer-specific requirements. Additionally, it is crucial to differentiate CPT 28122 from similar codes to ensure accurate billing and reimbursement.

8. Historical information

CPT 28122 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 28122

Five similar codes to CPT 28122 and how they differentiate are:

• CPT 28120: Involves partial excision of the talus or calcaneus bone, rather than the tarsal or metatarsal bones.
• CPT 28124: Focuses on the partial excision of the phalanx of the toe, instead of the tarsal or metatarsal bones.
• CPT 28289: Refers to a cheilectomy for hallux rigidus, which is a different procedure targeting the big toe joint.
• CPT 28119: Describes the excision of a bone spur or exostosis of the talus or calcaneus, not a partial excision of the tarsal or metatarsal bones.
• CPT 28118: Involves the excision of a bone spur or exostosis of the tarsal or metatarsal bones, not a partial excision.

10. Examples

Here are 10 detailed examples of CPT code 28122 procedures:

1. A patient with chronic osteomyelitis of the second metatarsal bone undergoes a partial excision of the infected bone using the craterization technique.
2. A patient with bossing of the navicular bone undergoes a partial excision using the saucerization technique to alleviate pain and improve function.
3. A patient with osteomyelitis of the cuboid bone undergoes a partial excision using the sequestrectomy technique to remove the infected portion of the bone.
4. A patient with bossing of the medial cuneiform bone undergoes a partial excision using the diaphysectomy technique to correct the deformity.
5. A patient with osteomyelitis of the third metatarsal bone undergoes a partial excision using the craterization technique, followed by a bone graft to fill the cavity.
6. A patient with bossing of the lateral cuneiform bone undergoes a partial excision using the saucerization technique, followed by a bone graft to fill the cavity.
7. A patient with osteomyelitis of the intermediate cuneiform bone undergoes a partial excision using the sequestrectomy technique, followed by a bone graft to fill the cavity.
8. A patient with bossing of the fourth metatarsal bone undergoes a partial excision using the diaphysectomy technique, followed by a bone graft to fill the cavity.
9. A patient with osteomyelitis of the fifth metatarsal bone undergoes a partial excision using the craterization technique, followed by a bone graft to fill the cavity.
10. A patient with bossing of the first metatarsal bone undergoes a partial excision using the saucerization technique, followed by a bone graft to fill the cavity.