How To Use CPT Code 28525

CPT 28525 describes the open treatment of a fracture in a toe other than the great toe, including internal fixation if necessary. 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 28525?

CPT 28525 can be used to describe the open treatment of a fracture in a toe other than the great toe. The procedure may involve the use of internal fixation, such as pins or screws, to stabilize the fracture. This code is used when the provider performs the treatment for each toe phalanx fracture in a toe other than the great toe.

2. Official Description

The official description of CPT code 28525 is: ‘Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each.’

3. Procedure

1. The provider begins by making an incision in the skin over the fractured phalanx bone in a toe other than the great toe.
2. They then carefully dissect through the subcutaneous tissue, taking care to protect the nerves and vessels.
3. The provider retracts the muscles to gain adequate exposure of the phalanx fracture.
4. Next, they adjust the bone to align the fractured fragments.
5. If necessary, the provider may use implants like screws, nails, or wires to fixate the fracture and promote proper healing.
6. Finally, they close the wound by suturing the skin layers together and place the toe in a splint or brace for approximately four weeks.

4. Qualifying circumstances

CPT 28525 is used for patients who have a fracture in a toe other than the great toe that requires open treatment. The procedure may involve the use of internal fixation, such as pins or screws, to stabilize the fracture. The provider must carefully assess the patient’s condition and determine the need for open treatment. This code should only be used for fractures in the phalanx or phalanges of a toe other than the great toe.

5. When to use CPT code 28525

CPT code 28525 should be used when the provider performs open treatment of a fracture in a toe other than the great toe, including internal fixation if necessary. This code should be reported for each toe phalanx fracture treated by the provider. It is important to note that this code should not be used for fractures in the great toe or for closed treatment of fractures in a toe other than the great toe.

6. Documentation requirements

To support a claim for CPT 28525, the provider must document the following information:

• The diagnosis of a fracture in a toe other than the great toe
• A detailed description of the procedure performed, including any internal fixation used
• The date of the procedure
• The start and end time of the procedure
• Any additional procedures or services provided during the same encounter
• The provider’s signature

7. Billing guidelines

When billing for CPT 28525, ensure that the procedure performed is open treatment of a fracture in a toe other than the great toe, including internal fixation if necessary. This code should not be reported with other codes for closed treatment of fractures in a toe other than the great toe. It is important to follow the specific guidelines provided by the payer and use appropriate modifiers if necessary.

8. Historical information

CPT 28525 was added to the Current Procedural Terminology system on January 1, 1990. On January 1, 2008, the code description was updated to include the option of internal or external fixation.

9. Examples

1. A provider performs open treatment with internal fixation for a fracture in the second toe phalanx.
2. A patient presents with a fracture in the fourth toe phalanx, and the provider performs open treatment with internal fixation.
3. A provider treats a fracture in the third toe phalanx with open treatment and uses screws for internal fixation.
4. A patient sustains a fracture in the fifth toe phalanx, and the provider performs open treatment with internal fixation using pins.
5. A provider performs open treatment with internal fixation for a fracture in the third toe phalanges.
6. A patient presents with a fracture in the fourth toe phalanges, and the provider performs open treatment with internal fixation.
7. A provider treats a fracture in the second toe phalanges with open treatment and uses screws for internal fixation.
8. A patient sustains a fracture in the fifth toe phalanges, and the provider performs open treatment with internal fixation using pins.
9. A provider performs open treatment with internal fixation for a fracture in the third toe phalanges.
10. A patient presents with a fracture in the fourth toe phalanges, and the provider performs open treatment with internal fixation.