Podiatry Coding & Billing Alert

Hint: 2 types of hammertoe include flexible and rigid.

If your podiatrist sees hammertoe patients in your practice, you know this condition can be tricky to code. Not only must you know if the patient has acquired or congenital hammertoe, but you must also know the two different types and the correct CPT^® codes to report if the patient requires corrective surgery.

Read on to learn more.

First, Define Hammertoe for Clarity

Question: What is a hammertoe?

Answer: Hammertoe occurs when your toe bends downward in a curled or fixed position resembling a hammer.

Learn Causes of Acquired Hammertoe

Question: What causes acquired hammertoe?

Answer: Common causes of acquired hammertoe include improperly fitting shoes, a muscle imbalance, and arthritis. Pressure from a bunion can also cause acquired hammertoe.

Don’t miss: Patients with high arches are prone to developing hammertoes.

Decipher How Podiatrists Diagnose Hammertoe

Question: How do podiatrists diagnose hammertoe?

Answer: Podiatrists can diagnose hammertoe by performing a physical exam of the patient’s foot to study the contracture of the toes and using imaging techniques like X-rays to identify the degree of the deformity.

If Patient Has Acquired Hammertoe, Rely on These M20- Codes

Question: What ICD-10-CM codes can I report for acquired hammertoe?

Answer: Your ICD-10-CM options for acquired hammertoe include the following codes:

• M20.40 (Other hammer toe(s) (acquired), unspecified foot))
• M20.41 (Other hammer toe(s) (acquired), right foot))
• M20.42 (Other hammer toe(s) (acquired), left foot))

Turn to Q66.89 in Case of Congenital Hammertoe

Question: My podiatrist documented a case of congenital hammertoe in the patient’s left foot. Which ICD-10-CM code should I report?

Answer: For congenital hammertoe, you should look to code Q66.89 (Other specified congenital deformities of feet). If you look in your ICD-10-CM manual under this code, you will see that it covers the following conditions, including congenital hammertoe:

• Congeni tal asymmetric talipes
• Congenital clubfoot NOS
• Congenital talipes NOS
• Congenital tarsal coalition
• Hammer toe, congenital

Identify 2 Types of Hammertoe

Question: What are the different types of hammertoes?

Answer: The two types of hammertoes are the following:

• Flexible hammertoe: If the patient’s toe can still be moved at the joint, then it’s a flexible hammertoe. This type is considered an earlier, milder form of the condition.
• Rigid hammertoe: If the tendons in the patient’s toe have become rigid, then they will press the joint out of alignment and the toe can’t move. Rigid hammertoe is considered more developed than flexible hammertoe.

Patient Needs Corrective Surgery for Rigid Hammertoe? Do This

Question: What are the temporary and permanent treatment options for hammertoe?

Answer: Temporary treatment options for hammertoe include an orthotic device to regulate muscle imbalance, a splint to realign the toe, wearing more comfortable shoes, and taking NSAIDS to relieve the pain.

On the other hand, to fix hammertoe permanently, the patient will need surgery, and for rigid hammertoe, surgery is the only possible treatment option. During the procedure, the surgeon will roughen up the cartilage on the base of the middle phalanx to promote arthrofibrosis, and the complex is then straightened and fixed with a K-wire.

CPT^® code: When your podiatrist performs a flexible or rigid hammertoe correction, you can report this procedure with 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]).

Coding example: For a patient with right-footed, acquired, rigid hammertoe, your podiatrist performs a hammertoe correction via a total phalangectomy and a capsulotomy for one joint with tenorrhaphy. You should report 28285 and M20.41 (Other hammer toe(s) (acquired), right foot) on your claim.

Also, please make sure the correct words are bolded. Just the “Question” and “Answer” should be in bold. Also, check the symbol on CPT^® to make sure it is the correct size.