You can bill CPT 28285 for hammertoe corrections. Add the T modifiers for multiple hammertoe correction procedures.
1. What Is CPT Code 28285?
This code covers a hammertoe repair procedure. A hammertoe is a toe that is permanently bent downwards. This painful condition can be corrected with the 28285 CPT code procedure.
2. What Is A Hammertoe?
A hammertoe often happens to the patient’s second, third, or fourth toe. It is a painful toe deformity usually caused by shoes that compress the toes too much.
Other causes of a hammertoe are;
- disease-based muscle imbalance;
- diabetes; or
- chronic tightness of the flexor digitorum leg muscle.
Treatment of a hammertoe depends if the deformity is supple or fixed.
The CPT book describes CPT 28285 as follows: “Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy).”
The 28285 CPT code procedure starts with an incision over the proximal interphalangeal joint after the patient is anesthetized and prepped. Then, the provider cuts (or sections) the ligaments on both sides.
They continue the procedure by exposing the proximal interphalangeal joint and the neck and head of the proximal phalanx (the toe bone closest to the body). They then use a rongeur to remove the proximal phalanx.
After removing the proximal phalanx, they insert a wire into the proximal and middle phalanges and use it to fuse the proximal interphalangeal joint.
Finally, they end the hammertoe repair procedure by rinsing the area, closing the incision, removing instruments, checking for bleeding, and applying a cast.
4. Billing Guidelines
Report CPT code 28285 for every fixed toe if you bill a multiple hammertoe correction procedure. Make sure to add the T modifiers (toe modifiers or anatomic modifiers) and add one modifier per line time.
Be aware that the toe modifiers were traditionally used for ASC (ambulatory surgery centers) or other outpatient facilities. The anatomic modifiers are only recently accepted for physician billing.
Therefore, getting the toe modifiers accepted by some carriers can still be challenging. Check their guidelines to ensure that you have provided all the necessary documentation for the claim.