How To Use CPT Code 28465

CPT 28465 describes the open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, if performed. 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 28465?

CPT 28465 can be used to describe the open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, if performed. This code is used when a provider performs an incision in the foot to reach the fractured tarsal bone, manually adjusts the fractured bone for proper placement, and may attach the fragments using screws and pins. The procedure does not include work on the talus or calcaneus.

2. Official Description

The official description of CPT code 28465 is: ‘Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, each.’

3. Procedure

1. The provider appropriately preps and anesthetizes the patient.
2. An incision is made in the foot to reach the fractured tarsal bone (excluding the talus and calcaneus).
3. The provider manually adjusts the fractured bone for proper placement.
4. If necessary, the provider may attach the fragments using screws and pins for internal fixation.
5. Hemostasis is ensured at the site to stop bleeding.
6. The excised area is closed in layers.

4. Qualifying circumstances

Patients eligible for CPT 28465 are those with a tarsal bone fracture (excluding the talus and calcaneus) that requires open treatment and internal fixation. The procedure is performed by a qualified provider. The talus and calcaneus are not included in this code.

5. When to use CPT code 28465

CPT code 28465 should be used when a provider performs open treatment of a tarsal bone fracture (excluding the talus and calcaneus) and includes internal fixation, if performed. This code should not be used for fractures involving the talus or calcaneus.

6. Documentation requirements

To support a claim for CPT 28465, the provider must document the following information:

• Patient’s diagnosis of a tarsal bone fracture (excluding the talus and calcaneus)
• Details of the procedure performed, including the incision, manual adjustment of the fractured bone, and use of screws and pins for internal fixation
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 28465, ensure that the procedure performed is open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, if performed. This code should not be reported for fractures involving the talus or calcaneus. It is important to follow the specific documentation requirements and guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 28465 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include open treatment of a tarsal bone fracture (except talus and calcaneus) with or without internal or external fixation.

9. Examples

1. A provider performs open treatment of a fractured tarsal bone (excluding the talus and calcaneus) in a patient’s foot, using internal fixation with screws.
2. During a surgical procedure, a provider performs open reduction and internal fixation of a tarsal bone fracture (excluding the talus and calcaneus) in a patient’s foot.
3. A patient undergoes open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, performed by a qualified provider.
4. A provider performs open reduction and internal fixation of a fractured tarsal bone (excluding the talus and calcaneus) in a patient’s foot, using screws and pins.
5. During a surgical procedure, a provider performs open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, ensuring proper alignment of the fractured bone.
6. A patient undergoes open reduction and internal fixation of a tarsal bone fracture (excluding the talus and calcaneus) in their foot, performed by a qualified provider.
7. A provider performs open treatment of a fractured tarsal bone (excluding the talus and calcaneus) in a patient’s foot, using internal fixation techniques.
8. During a surgical procedure, a provider performs open reduction and internal fixation of a tarsal bone fracture (excluding the talus and calcaneus) in a patient’s foot, ensuring stability and proper healing.
9. A patient undergoes open treatment of a tarsal bone fracture (excluding the talus and calcaneus) with internal fixation, performed by a qualified provider.
10. A provider performs open reduction and internal fixation of a fractured tarsal bone (excluding the talus and calcaneus) in a patient’s foot, using screws and pins for stabilization.