How To Use CPT Code 28515

CPT 28515 describes the closed treatment of a fracture in a toe other than the great toe, with manipulation of the fractured bone. 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 28515?

CPT 28515 can be used to describe the closed treatment of a fracture in a toe other than the great toe, with manipulation of the fractured bone. This code is used when the provider adjusts the fractured fragment in the toe by exerting pushing or pulling force to reduce the fracture. The toe is then placed in a splint or brace for a period of four weeks.

2. Official Description

The official description of CPT code 28515 is: ‘Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each.’

3. Procedure

1. The provider assesses the fracture in the toe other than the great toe and determines the need for closed treatment.
2. The patient is appropriately prepped and anesthetized.
3. The provider manipulates the fractured bone by exerting pushing or pulling force on the toe to reduce the fracture.
4. The toe is then placed in a splint or brace for a period of four weeks to support proper healing.
5. An X-ray examination may be performed to confirm the reduction of the fracture.

4. Qualifying circumstances

Patients eligible to receive CPT 28515 services are those with a fracture in a toe other than the great toe that requires closed treatment with manipulation. The provider must assess the fracture and determine the need for closed treatment. The patient must be appropriately prepped and anesthetized for the procedure. The toe is then manipulated to reduce the fracture, and a splint or brace is applied for four weeks to support proper healing.

5. When to use CPT code 28515

CPT code 28515 should be used when the provider performs closed treatment of a fracture in a toe other than the great toe, with manipulation of the fractured bone. This code should be used for each toe phalanx fracture treated by the provider.

6. Documentation requirements

To support a claim for CPT 28515, the provider must document the following information:

• Diagnosis of the toe fracture and the need for closed treatment
• Details of the manipulation performed to reduce the fracture
• Date of the procedure
• Application of a splint or brace for four weeks
• Confirmation of the reduction of the fracture, if an X-ray examination is performed

7. Billing guidelines

When billing for CPT 28515, ensure that the provider performs closed treatment of a fracture in a toe other than the great toe, with manipulation of the fractured bone. This code should not be reported with CPT code 28510, which is used for closed treatment of a toe fracture without manipulation. It should also not be reported with CPT code 28525, which is used for open treatment of a toe fracture with or without internal fixation. Use one unit of CPT code 28515 for each toe phalanx fracture treated by the provider.

8. Historical information

CPT 28515 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 second toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a splint for four weeks.
2. A patient sustains a fracture in their fourth toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a brace for four weeks.
3. A patient fractures their fifth toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a splint for four weeks.
4. A patient fractures their third toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a brace for four weeks.
5. A patient presents with a fracture in their second toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a splint for four weeks.
6. A patient sustains a fracture in their fourth toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a brace for four weeks.
7. A patient fractures their fifth toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a splint for four weeks.
8. A patient fractures their third toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a brace for four weeks.
9. A patient presents with a fracture in their second toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a splint for four weeks.
10. A patient sustains a fracture in their fourth toe. The provider performs closed treatment of the fracture, manipulating the fractured bone and applying a brace for four weeks.