How To Use CPT Code 28308

CPT 28308 refers to a specific osteotomy procedure performed on metatarsal bones other than the first, which may involve lengthening, shortening, or angular correction. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 28308.

1. What is CPT 28308?

CPT 28308 is a medical code used to describe a specific type of osteotomy procedure performed on metatarsal bones other than the first. This procedure may involve lengthening, shortening, or angular correction of the metatarsal bone to repair a foot deformity and realign the metatarsal bone and the toe.

2. 28308 CPT code description

The official description of CPT code 28308 is: “Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each.”

3. Procedure

The 28308 CPT code procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an incision over a metatarsophalangeal joint, except for the first metatarsal.
3. The incision is deepened through skin and soft tissue, with care taken to identify and retract all vital neurovascular structures.
4. The medial eminence, or bony bump or prominence, is excised from the metatarsal bone.
5. If needed, the bone is lengthened by transecting it and pulling the two pieces apart slightly, allowing osseous (bony) regrowth to fill in the gap.
6. If needed, the metatarsal bone is shortened by removing a portion of the bone and rejoining the two ends with a screw or wire.
7. To correct an angular deformity, the metatarsal bone is realigned with the toe and fixed into place with metal screws to ensure proper healing alignment.
8. The provider checks for and controls any bleeding, removes any instruments, and closes the incision in layers.

4. Qualifying circumstances

Patients eligible to receive CPT 28308 services are those with foot deformities or misalignments involving metatarsal bones other than the first. These deformities may include conditions such as hammertoe, claw toe, or other metatarsal-related issues that require surgical intervention to correct the alignment and restore proper function.

5. When to use CPT code 28308

It is appropriate to bill the 28308 CPT code when a provider performs an osteotomy on a metatarsal bone other than the first, with or without lengthening, shortening, or angular correction. This code should be used for each separate osteotomy performed on a metatarsal other than the first during a single procedure.

6. Documentation requirements

To support a claim for CPT 28308, the following information should be documented:

• Patient’s medical history and physical examination findings, including the specific foot deformity or misalignment being addressed.
• Preoperative imaging studies, such as X-rays, demonstrating the metatarsal deformity or misalignment.
• Details of the surgical procedure, including the specific metatarsal bone(s) involved, the type of osteotomy performed (lengthening, shortening, or angular correction), and any hardware used for fixation.
• Postoperative care instructions and follow-up appointments.
• Any complications or adverse events encountered during the procedure.

7. Billing guidelines

When billing for CPT 28308, it is essential to follow specific guidelines and rules to ensure proper reimbursement. These guidelines include checking whether insurers will pay for a surgical assistant during the procedure and using the appropriate modifiers to represent the assistant’s work. Additionally, if multiple osteotomies are performed in a single procedure, use CPT code 28309 instead of billing multiple instances of CPT 28308.

8. Historical information

CPT 28308 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 28308

Five similar codes to CPT 28308 and how they differentiate are:

• CPT 28309: This code is used for multiple osteotomies in a single procedure, such as the Swanson type cavus foot procedure.
• CPT 28310: This code refers to an osteotomy of the first metatarsal, with or without lengthening, shortening, or angular correction.
• CPT 28315: This code is used for an osteotomy of the phalanx of the foot, with or without internal fixation.
• CPT 28320: This code refers to a repair of a metatarsal nonunion or malunion, with or without internal fixation.
• CPT 28322: This code is used for an excision of a metatarsal exostosis, with or without soft tissue release.

10. Examples

Here are 10 detailed examples of CPT code 28308 procedures:

1. Osteotomy of the second metatarsal with lengthening to correct a hammertoe deformity.
2. Osteotomy of the third metatarsal with shortening to address a claw toe deformity.
3. Angular correction osteotomy of the fourth metatarsal to realign a misaligned toe joint.
4. Osteotomy of the fifth metatarsal with shortening and angular correction to treat a bunionette deformity.
5. Lengthening osteotomy of the second metatarsal to correct a metatarsalgia-related issue.
6. Shortening osteotomy of the third metatarsal to address a painful plantar callus.
7. Angular correction osteotomy of the fourth metatarsal to treat a crossover toe deformity.
8. Osteotomy of the second and third metatarsals with lengthening to correct a severe hammertoe deformity affecting multiple toes.
9. Osteotomy of the fifth metatarsal with shortening and angular correction to address a recurrent bunionette deformity.
10. Lengthening osteotomy of the fourth metatarsal to correct a metatarsalgia-related issue affecting multiple metatarsal bones.