How To Use CPT Code 28153

CPT 28153 describes the surgical procedure of resection of the condyle at the distal end of the phalanx, resulting in the amputation of the toe. This article will provide an overview of CPT code 28153, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28153?

CPT 28153 is a code used to describe the surgical removal of the condyle at the distal end of the phalanx, which leads to the amputation of the toe. This procedure is typically performed when there is a need to address a specific condition or injury affecting the toe. It involves making an incision over the affected metatarsophalangeal or interphalangeal joint of the foot, carefully retracting the nerves and tendons, identifying the condyle of the affected phalanx bone, and removing the distal end of the phalanx using a bone saw. The provider then closes the wound in layers.

2. Official Description

The official description of CPT code 28153 is: ‘Resection, condyle(s), distal end of phalanx, each toe.’

3. Procedure

1. The provider prepares the patient for the procedure, ensuring appropriate prepping and anesthesia.
2. An incision is made over the affected metatarsophalangeal or interphalangeal joint of the foot.
3. The provider carefully retracts the nerves and tendons to gain access to the condyle of the affected phalanx bone.
4. The condyle, which is the rounded projection on the lower end of the bone, is identified and exposed.
5. Using a bone saw, the provider removes the distal end of the phalanx, which is the far end of the bone.
6. The provider then joins the skin flaps and closes the wound in layers.

4. Qualifying circumstances

CPT 28153 is performed when there is a need to surgically remove the condyle at the distal end of the phalanx, resulting in the amputation of the toe. This procedure is typically indicated for specific conditions or injuries affecting the toe that cannot be effectively treated through other means. It is important to note that this procedure should only be performed by a qualified healthcare professional with the necessary expertise and training in surgical techniques.

5. When to use CPT code 28153

CPT code 28153 should be used when the provider performs the surgical resection of the condyle at the distal end of the phalanx, resulting in the amputation of the toe. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code. This code should not be used for any other procedures or conditions that do not involve the resection of the condyle at the distal end of the phalanx.

6. Documentation requirements

To support a claim for CPT code 28153, the provider must document the following information:

• Patient’s diagnosis or condition necessitating the procedure
• Details of the surgical procedure performed, including the specific toe and the resection of the condyle at the distal end of the phalanx
• Date of the procedure
• Any additional relevant information or findings during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 28153, it is important to ensure that the procedure performed meets the specific criteria outlined in the official description. The provider should report this code once per toe if the procedure is performed on multiple toes. It is also important to follow any additional guidelines or requirements set forth by the payer or insurance company. It is recommended to review the specific billing guidelines and requirements for CPT code 28153 to ensure accurate and appropriate billing.

8. Historical information

CPT code 28153 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 surgical resection of the condyle at the distal end of the phalanx of their big toe due to a severe injury.
2. A provider performs the amputation of the second toe by surgically removing the condyle at the distal end of the phalanx.
3. A patient with a chronic condition undergoes the surgical resection of the condyle at the distal end of the phalanx of their fifth toe.
4. A provider performs the amputation of the third toe by surgically removing the condyle at the distal end of the phalanx.
5. A patient with a congenital deformity undergoes the surgical resection of the condyle at the distal end of the phalanx of their fourth toe.
6. A provider performs the amputation of the great toe by surgically removing the condyle at the distal end of the phalanx.
7. A patient with a severe infection undergoes the surgical resection of the condyle at the distal end of the phalanx of their second toe.