How To Use CPT Code 28285

CPT 28285 refers to the correction of a hammertoe deformity through surgical procedures such as interphalangeal fusion or partial or total phalangectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 28285.

1. What is CPT 28285?

CPT 28285 is a medical code used to describe the surgical correction of a hammertoe deformity. Hammertoe is a painful condition where the toe remains permanently bent in a downward position. The surgical procedures involved in correcting this deformity include interphalangeal fusion, partial or total phalangectomy. This code is essential for medical professionals to accurately document and bill for the services provided during the hammertoe correction procedure.

2. 28285 CPT code description

The official description of CPT code 28285 is: “Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)”.

3. Procedure

1. The patient is prepped and anesthetized.
2. An incision is made over the proximal interphalangeal joint.
3. The ligaments on both sides are sectioned using a small blade.
4. The proximal interphalangeal joint is exposed.
5. The head and neck of the proximal phalanx are exposed and removed with a rongeur.
6. The proximal phalanx is completely removed.
7. A wire is inserted into the middle and proximal phalanges, and the proximal interphalangeal joint is fused.
8. The area is irrigated, checked for bleeding, and all instruments are removed.
9. The incision is closed, and a cast is applied.

4. Qualifying circumstances

Patients eligible to receive CPT code 28285 services are those diagnosed with a hammertoe deformity that causes significant pain or discomfort and affects their daily activities. The deformity may involve the second, third, or fourth toe and can be caused by various factors such as constricted toe boxes in shoes, diabetes, chronic tightness of the flexor digitorum muscle, disease-based muscle imbalance, or mild compartment syndrome following fractures of the tibia and foot. The treatment approach depends on whether the deformity is fixed or supple.

5. When to use CPT code 28285

It is appropriate to bill the 28285 CPT code when a provider performs a surgical correction of a hammertoe deformity through interphalangeal fusion, partial or total phalangectomy. The code should be used for each toe that undergoes the correction procedure, with the appropriate modifiers to specify the toe and any additional procedures performed.

6. Documentation requirements

To support a claim for CPT 28285, the following information should be documented:

• Patient’s medical history and physical examination findings
• Diagnosis of hammertoe deformity
• Conservative treatment measures attempted, if applicable
• Indications for surgical intervention
• Details of the surgical procedure, including the specific techniques used
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 28285, it is essential to use the appropriate modifiers for each toe that undergoes the correction procedure. T modifiers, such as T3 (Left foot, fourth digit), should be used to specify the toe and any additional procedures performed. Keep in mind that T modifiers are anatomic modifiers and can only be reported once per line item. They are traditionally used for ambulatory surgery centers (ASC) or other outpatient facilities and have only been approved for physician billing in recent years. Some carriers may still have difficulty accepting T modifiers from provider offices, so it is crucial to check carrier guidelines and have supporting documentation ready if needed.

8. Historical information

CPT 28285 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 28285

Five similar codes to CPT 28285 and how they differentiate are:

1. CPT 28270: This code refers to the surgical correction of a contracture of the foot, specifically the metatarsophalangeal joint.
2. CPT 28272: This code is used for the surgical correction of a claw toe deformity.
3. CPT 28280: This code describes the surgical repair of a syndactyly deformity, which involves the fusion of two or more toes.
4. CPT 28289: This code is used for the surgical correction of a hallux rigidus deformity, which affects the big toe.
5. CPT 28290: This code refers to the surgical correction of a bunion deformity, specifically a bunionectomy with or without sesamoidectomy.

10. Examples

Here are 10 detailed examples of CPT code 28285 procedures:

1. A patient with a painful hammertoe deformity on the second toe of the left foot undergoes interphalangeal fusion.
2. A patient with a fixed hammertoe deformity on the third toe of the right foot undergoes partial phalangectomy.
3. A patient with a supple hammertoe deformity on the fourth toe of the left foot undergoes total phalangectomy.
4. A patient with hammertoe deformities on the second and third toes of the right foot undergoes interphalangeal fusion on both toes.
5. A patient with a painful hammertoe deformity on the second toe of the left foot undergoes interphalangeal fusion and a concomitant bunionectomy.
6. A patient with a fixed hammertoe deformity on the third toe of the right foot undergoes partial phalangectomy and a concomitant claw toe correction on the fourth toe.
7. A patient with a supple hammertoe deformity on the fourth toe of the left foot undergoes total phalangectomy and a concomitant syndactyly repair on the third and fourth toes.
8. A patient with hammertoe deformities on the second and third toes of the right foot undergoes interphalangeal fusion on both toes and a concomitant hallux rigidus correction on the big toe.
9. A patient with a painful hammertoe deformity on the second toe of the left foot undergoes interphalangeal fusion and a concomitant metatarsophalangeal joint contracture correction on the third toe.
10. A patient with a fixed hammertoe deformity on the third toe of the right foot undergoes partial phalangectomy and a concomitant bunionectomy with sesamoidectomy on the big toe.