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The CPT® Code 28635 refers to the closed treatment of a dislocation at the metatarsophalangeal joint, which is the joint located at the base of the toe where the metatarsal bone meets the proximal phalanx. This procedure necessitates the use of anesthesia to ensure patient comfort during the manipulation of the dislocated joint. The process begins with a thorough evaluation of the neurovascular status of the foot and toes, which is crucial for assessing any potential damage to nerves or blood vessels. Following this assessment, radiographs, or X-rays, are obtained to visualize the dislocation and confirm the diagnosis. The closed reduction technique involves applying longitudinal traction to the affected toe while simultaneously exerting pressure on the involved metatarsal and phalangeal bones to realign the joint. After the reduction is successfully performed, the neurovascular status is re-evaluated, and a second set of radiographs is taken to ensure proper alignment has been achieved. To stabilize the joint post-procedure, the foot is immobilized in a splint, and the patient receives instructions to ice and elevate the foot to reduce swelling and promote healing. It is important to note that CPT® Code 28630 should be used when the dislocation is treated without the need for anesthesia.
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The closed treatment of metatarsophalangeal joint dislocation, as described by CPT® Code 28635, is indicated for patients presenting with a dislocated toe joint that requires intervention under anesthesia. This procedure is typically performed when the dislocation results in significant pain, instability, or functional impairment of the toe, necessitating a reduction to restore normal alignment and function.
The closed treatment procedure for a metatarsophalangeal joint dislocation involves several critical steps to ensure successful reduction and stabilization of the joint. Initially, the healthcare provider evaluates the neurovascular status of the foot and toes to check for any signs of nerve or blood vessel compromise. This assessment is essential for determining the extent of the injury and planning the appropriate intervention. Following this evaluation, separate radiographs are obtained to visualize the dislocation and confirm the diagnosis, providing a clear view of the joint's alignment.
Post-procedure care following the closed treatment of a metatarsophalangeal joint dislocation includes monitoring the immobilized foot for any signs of complications, such as increased pain, swelling, or changes in neurovascular status. Patients are advised to keep the foot elevated and apply ice to reduce swelling. Follow-up appointments may be scheduled to assess healing and to determine when it is appropriate to begin rehabilitation exercises to restore range of motion and strength. It is essential for patients to adhere to the immobilization instructions and to report any concerning symptoms to their healthcare provider promptly.
| Short Descr | TREAT TOE DISLOCATION | Medium Descr | CLTX METATARSOPHLNGL JT DISLC REQ ANES | Long Descr | Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 2 | CCS Clinical Classification | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | T1 | Left foot, second digit | T2 | Left foot, third digit | T3 | Left foot, fourth digit | T4 | Left foot, fifth digit | T5 | Right foot, great toe | T6 | Right foot, second digit | T7 | Right foot, third digit | T8 | Right foot, fourth digit | T9 | Right foot, fifth digit | TA | Left foot, great toe | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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