How To Use CPT Code 28490

CPT 28490 describes the non-surgical, non-manipulative treatment of a fracture in the great toe or phalanx. 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 28490?

CPT 28490 can be used to describe the closed treatment of a fracture in the great toe or phalanx without surgery and without manipulation. This means that the provider does not break the skin or realign the fractured bone. Instead, the provider typically tapes the broken toe to an adjacent toe to hold it in place for healing. Additional measures may include placing gauze between the toes for moisture absorption, instructing the patient to replace the tape and gauze as needed, and limiting weight-bearing on the affected foot. In some cases, a rigid flat-soled shoe or a fracture brace may be used. Patients with diabetes or toe numbness may require a different approach, such as wearing a rigid flat-soled shoe for up to three weeks or using crutches for walking.

2. Official Description

The official description of CPT code 28490 is: ‘Closed treatment of fracture great toe, phalanx or phalanges; without manipulation.’

3. Procedure

1. The provider confirms the fracture in the great toe or phalanx through X-ray.
2. The provider tapes the broken toe to an adjacent toe to hold it in place for healing.
3. Gauze may be placed between the toes for moisture absorption.
4. The patient is instructed to replace the tape and gauze as needed.
5. The provider advises the patient to elevate and limit weight-bearing on the affected foot.
6. In some cases, a rigid flat-soled shoe, fracture brace, or walking cast with a toe plate may be used.
7. Crutches may be recommended for walking, depending on the patient’s condition.

4. Qualifying circumstances

CPT 28490 is appropriate for patients with a fracture in the great toe or phalanx that can be treated without surgery and without manipulation. The provider does not break the skin or realign the fractured bone. This procedure is typically performed by a healthcare professional who confirms the fracture through X-ray and determines that non-surgical, non-manipulative treatment is suitable for the patient.

5. When to use CPT code 28490

CPT code 28490 should be used when the provider performs closed treatment of a fracture in the great toe or phalanx without surgery and without manipulation. It is important to note that this code should not be used if the provider breaks the skin or realigns the fractured bone.

6. Documentation requirements

To support a claim for CPT 28490, the provider must document the following information:

• Confirmation of the fracture through X-ray
• Description of the closed treatment procedure performed
• Instructions given to the patient regarding tape and gauze replacement, elevation, and weight-bearing limitations
• Details of any additional measures taken, such as the use of a rigid flat-soled shoe, fracture brace, or walking cast with a toe plate
• Any recommendations for crutch use

7. Billing guidelines

When billing for CPT 28490, ensure that the treatment performed meets the criteria of closed treatment without surgery and without manipulation. It is important to report any additional supplies of casting materials separately. Consider using the appropriate modifiers if necessary.

8. Historical information

CPT 28490 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient presents with a fracture in their great toe. The provider confirms the fracture through X-ray and performs closed treatment without surgery and without manipulation. The provider tapes the broken toe to an adjacent toe and instructs the patient to replace the tape and gauze as needed. The patient is advised to elevate the foot and limit weight-bearing. The provider documents the procedure and provides appropriate follow-up instructions.
2. Another patient has a fracture in their phalanx. The provider determines that closed treatment without surgery and without manipulation is suitable. The provider applies a rigid flat-soled shoe and advises the patient to wear it for up to three weeks. The patient is instructed to limit weight-bearing and replace the tape and gauze as needed. The provider documents the procedure and provides appropriate follow-up instructions.
3. A third patient presents with a fracture in their great toe. The provider confirms the fracture through X-ray and performs closed treatment without surgery and without manipulation. The provider applies a fracture brace and instructs the patient on its use. The patient is advised to limit weight-bearing and replace the tape and gauze as needed. The provider documents the procedure and provides appropriate follow-up instructions.