How To Use CPT Code 28234

CPT 28234 describes a specific procedure performed on the foot or toe to relieve tightness in the extensor tendon. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28234?

CPT 28234 is a code used to describe a surgical procedure performed on the foot or toe to relieve tightness in the extensor tendon. This procedure involves making an incision in the skin to access the affected tendon and dividing it to reduce tension. It is commonly used to treat conditions such as hammer toe, where the toe bends or curls unnaturally.

2. Official Description

The official description of CPT code 28234 is: ‘Tenotomy, open, extensor, foot or toe, each tendon.’ This code specifically refers to the surgical division of the extensor tendon in the foot or toe to alleviate tightness. It is important to note that this code does not cover tendon transfer procedures to the midfoot or hindfoot, which have their own specific codes (27690, 27691).

3. Procedure

1. To perform CPT 28234, the provider begins by preparing and anesthetizing the patient.
2. An incision is made over the target extensor tendon in the foot or toe, depending on the specific condition being treated.
3. The provider then divides the tendon, typically by inserting a scalpel into the affected tendon and rotating it to reduce tension.
4. In the case of hammer toe, the provider may perform the tenotomy at the crease of the toe and stretch it to the desired position and length.
5. Once the procedure is complete, the surgical field is closed, and a sterile dressing is applied.

4. Qualifying circumstances

CPT 28234 is typically performed on patients who have a condition that causes tightness in the extensor tendon of the foot or toe, such as hammer toe. The procedure is appropriate when conservative treatments have failed to alleviate the tightness and the patient is experiencing significant discomfort or functional impairment. It is important to note that this procedure should only be performed by a qualified healthcare professional with the necessary training and expertise.

5. When to use CPT code 28234

CPT code 28234 should be used when a provider performs an open tenotomy procedure on the extensor tendon of the foot or toe to relieve tightness. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure involves tendon transfer to the midfoot or hindfoot, a different code should be used (27690, 27691).

6. Documentation requirements

To support a claim for CPT 28234, the provider must document the following information:

• The specific extensor tendon targeted for the procedure
• The date of the procedure
• A detailed description of the procedure performed, including any modifications or variations
• The patient’s diagnosis and the medical necessity for the procedure
• Any complications or unexpected findings during the procedure
• Post-procedure instructions and follow-up plans
• The provider’s signature and credentials

7. Billing guidelines

When billing for CPT 28234, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should use the appropriate modifiers if multiple units are reported or if the procedure is performed on different tendons. It is also important to follow payer instructions and guidelines for reporting and reimbursement. It is recommended to consult with the payer or a coding specialist for specific billing guidelines related to CPT 28234.

8. Historical information

CPT 28234 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 podiatrist performing an open tenotomy procedure on the extensor tendon of a patient’s foot to alleviate tightness and correct hammer toe.
2. An orthopedic surgeon performing an open tenotomy procedure on the extensor tendon of a patient’s toe to relieve tightness caused by a specific condition.
3. A foot and ankle specialist performing an open tenotomy procedure on the extensor tendon of a patient’s foot to improve their ability to walk and reduce pain.
4. A hand surgeon performing an open tenotomy procedure on the extensor tendon of a patient’s finger to address a specific condition causing tightness and limited mobility.
5. An orthopedic specialist performing an open tenotomy procedure on the extensor tendon of a patient’s toe to correct a deformity and improve their overall foot function.