How To Use CPT Code 28750

CPT 28750 is a code for arthrodesis of the great toe’s metatarsophalangeal joint, a surgical procedure to treat end-stage osteoarthritis. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 28750.

1. What is CPT 28750?

CPT 28750 is a medical code used to describe a surgical procedure called arthrodesis of the metatarsophalangeal joint of the great toe. This procedure involves the surgical immobilization of the joint between the first metatarsal of the foot and the first phalanx of the great toe. It is primarily performed to treat pain in patients with end-stage osteoarthritis of the metatarsophalangeal joint of the great toe.

2. 28750 CPT code description

The official description of CPT code 28750 is: “Arthrodesis, great toe; metatarsophalangeal joint.”

3. Procedure

The CPT 28750 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. An incision is made in the skin over the affected joint at the base of the great toe.
3. The provider dissects down through subcutaneous tissue, preserving the nerves and veins.
4. The muscle tendon is retracted to gain access to the joint to be fused.
5. The joint capsule is cut, and the joint is entered.
6. All dead or inflamed tissue is removed from the joint cavity.
7. The bones of the joint are brought in close proximity, and the joint is fused using implants like K-wire, screws, or plates.
8. Hemostasis is obtained at the surgical site, and the wound is closed by suturing the soft tissue in layers.
9. The toe is placed in a splint or brace for a period of four weeks.

4. Qualifying circumstances

Patients eligible to receive CPT 28750 services are those who have been diagnosed with end-stage osteoarthritis of the metatarsophalangeal joint of the great toe and have not responded to conservative treatments such as medication, physical therapy, or orthotics. The procedure is typically recommended when the patient experiences significant pain, deformity, or loss of function that affects their daily activities and quality of life.

5. When to use CPT code 28750

It is appropriate to bill the 28750 CPT code when the provider performs arthrodesis of the metatarsophalangeal joint of the great toe to treat end-stage osteoarthritis. The procedure should be considered only after conservative treatments have failed to provide adequate pain relief or functional improvement for the patient.

6. Documentation requirements

To support a claim for CPT 28750, the following information should be documented:

• Patient’s medical history, including previous treatments and their outcomes.
• Physical examination findings, including the severity of pain, deformity, and loss of function.
• Radiographic or other imaging studies confirming the diagnosis of end-stage osteoarthritis of the metatarsophalangeal joint of the great toe.
• Indications for the procedure, such as failure of conservative treatments or significant impact on the patient’s quality of life.
• A detailed description of the surgical procedure, including the steps performed, implants used, and postoperative care plan.
• Operative report and any intraoperative findings or complications.
• Follow-up visits and progress notes, including any postoperative complications or additional treatments required.

7. Billing guidelines

When billing for CPT code 28750, it is essential to follow the specific guidelines and rules set by the payer. Some general tips include:

• Ensure that the documentation supports the medical necessity of the procedure.
• Verify the patient’s insurance coverage and obtain any necessary pre-authorizations.
• Use the appropriate modifiers, if applicable, to indicate any special circumstances related to the procedure.
• Include any related codes for additional procedures or services provided during the same encounter.
• Submit the claim with accurate and complete information to avoid delays or denials.

8. Historical information

CPT 28750 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 28750

Five similar codes to CPT 28750 and how they differentiate are:

• CPT 28755: This code is used for arthrodesis of an interphalangeal joint in the great toe, rather than the metatarsophalangeal joint.
• CPT 28730: This code describes arthrodesis of the midtarsal or tarsometatarsal joint, which are different joints in the foot.
• CPT 28740: This code is for arthrodesis of the subtalar joint, another joint in the foot not involving the great toe.
• CPT 28760: This code refers to arthrodesis of the triple joint complex, which includes multiple joints in the foot.
• CPT 28285: This code is for the correction of a hammertoe deformity, a different condition affecting the toes.

10. Examples

Here are 10 detailed examples of CPT code 28750 procedures:

1. A 55-year-old patient with end-stage osteoarthritis of the metatarsophalangeal joint of the great toe, unresponsive to conservative treatments, undergoes arthrodesis using a plate and screws.
2. A 65-year-old patient with severe pain and deformity due to osteoarthritis of the great toe’s metatarsophalangeal joint undergoes arthrodesis with K-wire fixation.
3. A 70-year-old patient with a history of failed conservative treatments for end-stage osteoarthritis of the metatarsophalangeal joint of the great toe undergoes arthrodesis using a combination of screws and plates.
4. A 60-year-old patient with significant pain and loss of function due to osteoarthritis of the metatarsophalangeal joint of the great toe undergoes arthrodesis with K-wire fixation and bone grafting.
5. A 50-year-old patient with end-stage osteoarthritis of the great toe’s metatarsophalangeal joint, unresponsive to medication and physical therapy, undergoes arthrodesis using a plate and screws.
6. A 45-year-old patient with severe pain and deformity due to osteoarthritis of the metatarsophalangeal joint of the great toe undergoes arthrodesis with K-wire fixation and bone grafting.
7. A 75-year-old patient with a history of failed conservative treatments for end-stage osteoarthritis of the metatarsophalangeal joint of the great toe undergoes arthrodesis using a combination of screws and plates.
8. A 62-year-old patient with significant pain and loss of function due to osteoarthritis of the great toe’s metatarsophalangeal joint undergoes arthrodesis with K-wire fixation.
9. A 58-year-old patient with end-stage osteoarthritis of the metatarsophalangeal joint of the great toe, unresponsive to medication and physical therapy, undergoes arthrodesis using a plate and screws.
10. A 67-year-old patient with severe pain and deformity due to osteoarthritis of the metatarsophalangeal joint of the great toe undergoes arthrodesis with K-wire fixation and bone grafting.