How To Use CPT Code 28825

CPT 28825 describes the surgical procedure of amputation at the interphalangeal joint of a toe. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28825?

CPT 28825 is a code used to describe the surgical removal of a toe at the interphalangeal joint. This procedure involves the complete or partial amputation of the toe, leaving the distal end of the limb, known as the stump. It is typically performed by a healthcare provider when other treatment options have been exhausted or when the toe is severely damaged or diseased.

2. Official Description

The official description of CPT code 28825 is: ‘Amputation, toe; interphalangeal joint.’ This code specifically refers to the surgical removal of a toe at the interphalangeal joint, which is the joint between the two phalanges of the toe.

3. Procedure

1. During the procedure, the healthcare provider begins by making an incision in the skin over the interphalangeal joint of the toe.
2. They then dissect through the subcutaneous tissue to access the joint.
3. The provider incises the joint capsule and separates the phalanx from the other phalanx.
4. Next, they ligate the blood vessels and retract the nerves to ensure proper surgical access.
5. The muscles’ tendons are transected and divided.
6. Finally, the toe is resected or cut at the interphalangeal joint, and the wound is irrigated with antibiotics before closing the incision with sutures and applying antiseptic gauze.

4. Qualifying circumstances

CPT 28825 is typically performed when there is a medical necessity for the amputation of a toe at the interphalangeal joint. This may be due to severe trauma, infection, tumor, or other conditions that cannot be effectively treated through conservative measures. The decision to perform this procedure is made by the healthcare provider based on the patient’s individual circumstances and the best course of treatment.

5. When to use CPT code 28825

CPT code 28825 should be used when a healthcare provider performs the surgical amputation of a toe at the interphalangeal joint. It is important to ensure that the procedure is accurately documented and meets the criteria outlined in the official description. This code should not be used for amputations involving other joints or when the toe is amputated along with the metatarsal bone (use CPT code 28810) or at the metatarsophalangeal joint (use CPT code 28820).

6. Documentation requirements

To support a claim for CPT 28825, the healthcare provider must document the following information:

• Indication for the amputation and the medical necessity
• Details of the procedure, including the specific toe and interphalangeal joint involved
• Incision site and approach used
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings
• Post-operative care instructions and follow-up plans

7. Billing guidelines

When billing for CPT 28825, it is important to ensure that the procedure meets the criteria outlined in the official description. The healthcare provider should use the appropriate CPT code based on the specific toe and interphalangeal joint involved. It is also important to follow any additional guidelines provided by the payer or coding guidelines. It is recommended to review the specific billing guidelines and requirements of the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 28825 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 healthcare provider performs an amputation at the interphalangeal joint of the fifth toe due to severe trauma.
2. A patient with a chronic infection in the second toe undergoes an amputation at the interphalangeal joint to prevent further spread of the infection.
3. A healthcare provider amputates the third toe at the interphalangeal joint due to a malignant tumor.
4. An individual with a congenital deformity in the fourth toe undergoes an amputation at the interphalangeal joint to improve functionality.
5. A patient with severe osteoarthritis in the first toe undergoes an amputation at the interphalangeal joint to relieve pain and improve mobility.
6. A healthcare provider performs an amputation at the interphalangeal joint of the second toe due to complications from diabetes.
7. An individual with a non-healing ulcer in the fifth toe undergoes an amputation at the interphalangeal joint to promote wound healing.
8. A patient with a severe infection in the third toe undergoes an amputation at the interphalangeal joint to prevent the spread of the infection to other toes.
9. A healthcare provider amputates the fourth toe at the interphalangeal joint due to a non-responsive nerve condition.
10. An individual with a traumatic injury to the first toe undergoes an amputation at the interphalangeal joint to restore function and alleviate pain.