How To Use CPT Code 28126

CPT 28126 describes the resection of the phalangeal base, either partially or completely, for each toe. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28126?

CPT 28126 is used to describe the surgical procedure in which the provider removes the infected portion of the toe bones. This code is specifically for the resection of the phalangeal base, either partially or completely, for each toe.

2. Official Description

The official description of CPT code 28126 is the “Resection, partial or complete, phalangeal base, each toe.” This code is used when the provider surgically removes a portion of the toe bones from the phalangeal base.

3. Procedure

1. When performing CPT 28126, the provider begins by appropriately prepping and anesthetizing the patient.
2. An incision is made on the affected toe, and the provider carefully dissects the soft tissues and tendons.
3. The infected bone is identified, and the provider proceeds to partially or completely resect the infected portion from the phalangeal base.
4. Finally, the wound is closed in layers to promote proper healing.

4. Qualifying circumstances

CPT 28126 is typically performed on patients who have an infection in the toe bones that requires surgical intervention. The procedure is indicated when there is a need to remove the infected portion of the bone from the phalangeal base. It is important to note that this code is specific to each toe, so multiple units of the code should be reported if the provider addresses multiple toes.

5. When to use CPT code 28126

CPT code 28126 should be used when the provider performs a resection of the phalangeal base, either partially or completely, for each toe. This code is appropriate when there is an infection in the toe bones that requires surgical removal of the infected portion.

6. Documentation requirements

To support a claim for CPT 28126, the provider must document the following information:

• The diagnosis indicating the need for the surgical procedure
• A detailed description of the procedure performed, including whether it was a partial or complete resection
• The specific toe or toes on which the procedure was performed
• Any additional procedures or techniques used during the surgery
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and follow-up plans

7. Billing guidelines

When billing for CPT 28126, ensure that the procedure performed matches the description of the code. It is important to report the correct number of units of the code based on the number of toes addressed during the surgery. Additionally, be aware of any specific payer guidelines or modifiers that may be required for accurate billing.

8. Historical information

CPT 28126 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a surgical procedure in which the provider performs a partial resection of the phalangeal base of the big toe to remove an infected portion of the bone.
2. A provider performs a complete resection of the phalangeal base of the second toe to address an infection in the toe bones.
3. During surgery, the provider performs a partial resection of the phalangeal base of the third and fourth toes to remove infected portions of the bones.
4. A patient requires a complete resection of the phalangeal base of all five toes to address widespread infection in the toe bones.
5. The provider performs a partial resection of the phalangeal base of the fifth toe to remove an infected portion of the bone.
6. A surgical procedure involves a complete resection of the phalangeal base of the second and third toes to address infections in both toes.
7. The provider performs a partial resection of the phalangeal base of the big toe and the fourth toe to remove infected portions of the bones.
8. A patient undergoes a complete resection of the phalangeal base of the third toe to address an infection in the toe bone.
9. During surgery, the provider performs a partial resection of the phalangeal base of the second and fourth toes to remove infected portions of the bones.
10. A complete resection of the phalangeal base of the big toe is performed to address a severe infection in the toe bone.