How To Use CPT Code 28496

CPT 28496 describes the percutaneous skeletal fixation of a fracture in the great toe’s phalanx or phalanges, with manipulation. 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 28496?

CPT 28496 can be used to describe the percutaneous skeletal fixation of a fracture in the phalanx or phalanges of the great toe, with manipulation. This code is used when the provider performs treatment for a fracture in the great toe using screws and pins inserted through the skin. The treatment includes the adjustment or manipulation of the fractured bone to restore proper alignment.

2. Official Description

The official description of CPT code 28496 is: ‘Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. The provider then manipulates the fractured fragment by applying force to the toe, either pushing or pulling, to realign the fracture.
3. A small incision is made in the skin over the fractured site.
4. Pins and screws are inserted through the incision to hold the reduced fracture fragments in place.
5. The toe is placed in a splint or brace for a period of four weeks to support proper healing.
6. An X-ray examination may be performed separately to confirm the reduction of the fracture.

4. Qualifying circumstances

CPT 28496 is performed when a patient has a fracture in the phalanx or phalanges of the great toe that requires percutaneous skeletal fixation with manipulation. The provider must adjust the fractured bone to restore proper alignment. The procedure is typically performed by an orthopedic surgeon or a qualified healthcare professional with expertise in skeletal fixation.

5. When to use CPT code 28496

CPT code 28496 should be used when a provider performs percutaneous skeletal fixation of a fracture in the great toe’s phalanx or phalanges, with manipulation. This code is appropriate when the procedure involves the use of screws and pins inserted through the skin to hold the reduced fracture fragments in place. It should not be used for closed treatment of a fracture without manipulation or for open treatment of a fracture with or without internal fixation.

6. Documentation requirements

To support a claim for CPT code 28496, the provider must document the following information:

• Patient’s diagnosis of a fracture in the great toe’s phalanx or phalanges
• Details of the manipulation performed to adjust the fractured fragment
• Description of the percutaneous skeletal fixation procedure, including the use of screws and pins
• Date of the procedure
• Start and end time of the procedure
• Use of a splint or brace for four weeks
• Confirmation of the reduction of the fracture through an X-ray examination, if performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 28496, ensure that the procedure involves percutaneous skeletal fixation of a fracture in the great toe’s phalanx or phalanges, with manipulation. It should not be reported with other codes for closed or open treatment of fractures in different locations. It is important to follow the specific guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT code 28496 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 patient presents with a fracture in the phalanx of their great toe. The provider performs percutaneous skeletal fixation with manipulation, using screws and pins to hold the reduced fracture fragments in place.
2. During a soccer game, a player sustains a fracture in the phalanges of their great toe. The orthopedic surgeon performs percutaneous skeletal fixation with manipulation, realigning the fractured bone and securing it with screws and pins.
3. An individual accidentally drops a heavy object on their foot, resulting in a fracture in the phalanges of their great toe. The provider performs percutaneous skeletal fixation with manipulation, ensuring proper alignment of the fractured bone using screws and pins.
4. A patient trips and falls, fracturing the phalanx of their great toe. The orthopedic surgeon performs percutaneous skeletal fixation with manipulation, adjusting the fractured fragment and stabilizing it with screws and pins.
5. During a hiking trip, a hiker injures their foot and sustains a fracture in the phalanges of their great toe. The provider performs percutaneous skeletal fixation with manipulation, using screws and pins to hold the fractured bone in place and promote proper healing.
6. A patient involved in a car accident presents with a fracture in the phalanx of their great toe. The orthopedic surgeon performs percutaneous skeletal fixation with manipulation, realigning the fractured bone and securing it with screws and pins.
7. An athlete experiences a sports-related injury, resulting in a fracture in the phalanges of their great toe. The provider performs percutaneous skeletal fixation with manipulation, ensuring proper alignment of the fractured bone using screws and pins.
8. A patient slips on ice and fractures the phalanx of their great toe. The orthopedic surgeon performs percutaneous skeletal fixation with manipulation, adjusting the fractured fragment and stabilizing it with screws and pins.
9. During a dance rehearsal, a dancer injures their foot and sustains a fracture in the phalanges of their great toe. The provider performs percutaneous skeletal fixation with manipulation, using screws and pins to hold the fractured bone in place and promote proper healing.