Podiatry Coding & Billing Alert

Question: My podiatrist fused the proximal interphalangeal joint (PIPJ) of a patient's big toe to reduce pain and improve stability. At the same time, he transferred the flexor tendon of the second toe to correct a hammertoe. How do I bill these two procedures?

Arizona Subscriber

Answer: You should bill the two procedures separately. The primary procedure in this surgery is the arthrodesis of the PIPJ. Use 28755 (Arthrodesis, great toe, interphalangeal joint) for this procedure.

The tendon transfer in this case is a secondary procedure. You should report 28313 (Reconstruction, angular deformity of toe, soft tissue procedures only [e.g., overlapping second toe, fifth toe, curly toes]) for the tendon transfer.

Then, attach LT (Left side) or RT (Right side) to indicate on which foot your podiatrist performed the procedure.

Watch for: For 28313, your payer may require you to use HCPCS Level II modifiers T1-TA (Left foot, second digit -- Left foot, great toe) to indicate the specific digit involved. Be sure to check with your payer to see if you need to append these modifiers.