How To Use CPT Code 28160

CPT 28160 describes the surgical procedure of hemiphalangectomy or interphalangeal joint excision for the 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 28160?

CPT 28160 is used to describe the surgical removal of a portion of the phalanges or interphalangeal joint of the toe. This procedure is typically performed to treat conditions such as trauma, infection, or tumors affecting the toe. It involves the excision of the proximal end of the phalanx or the joint itself.

2. Official Description

The official description of CPT code 28160 is: ‘Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each.’

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. An incision is made over the affected metatarsophalangeal joint or interphalangeal joint.
3. The provider carefully retracts the nerves and tendons to expose the proximal end of the phalanx.
4. Using a bone cutting instrument, the provider removes the desired portion of the bone or the entire joint.
5. The wounds are closed in layers to promote proper healing.

4. Qualifying circumstances

CPT 28160 is performed on patients who require the surgical removal of a portion of the toe’s phalanges or interphalangeal joint. This procedure is typically indicated for conditions such as trauma, infection, or tumors affecting the toe. The provider must carefully assess the patient’s condition and determine the need for this surgical intervention.

5. When to use CPT code 28160

CPT code 28160 should be used when the provider performs a hemiphalangectomy or interphalangeal joint excision on the toe. It is important to accurately document the specific procedure performed and ensure that it aligns with the description provided by CPT 28160.

6. Documentation requirements

To support a claim for CPT 28160, the provider must document the following information:

• Patient’s diagnosis necessitating the procedure
• Specific details of the surgical intervention, including the location and extent of the excision
• Date of the procedure
• Any additional procedures or interventions performed during the same session
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 28160, it is important to ensure that the procedure performed aligns with the description provided by the code. Report CPT 28160 once per toe if the provider performs the procedure on multiple toes. It is also essential to follow any specific guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT 28160 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 hemiphalangectomy on their right big toe to treat a traumatic injury.
2. A provider performs an interphalangeal joint excision on the second toe of a patient with a tumor.
3. A surgical team performs a hemiphalangectomy on the left little toe of a patient with a severe infection.
4. A provider performs an interphalangeal joint excision on the third toe of a patient with a chronic condition.
5. A patient undergoes a hemiphalangectomy on their right fourth toe to address a congenital abnormality.
6. A provider performs an interphalangeal joint excision on the left fifth toe of a patient with a degenerative joint disease.
7. A surgical team performs a hemiphalangectomy on the right second toe of a patient with a tumor.
8. A provider performs an interphalangeal joint excision on the third toe of a patient with a severe infection.
9. A patient undergoes a hemiphalangectomy on their left fourth toe to address a traumatic injury.
10. A provider performs an interphalangeal joint excision on the right fifth toe of a patient with a chronic condition.