Podiatry Coding & Billing Alert

Look to 28010, 28011 for percutaneous tenotomies.

According to your podiatrist’s medical documentation, the patient has a reducible hammertoe with all soft tissue and no bone involvement. The podiatrist performs surgery to correct it. Do you know whether you should report an inclusive hammertoe code or just a tenotomy code for this service?

Read on to learn more and to keep your claims in tip-top shape.

Rely on These Codes When Podiatrist Performs Tenotomy Only

When the patient has a reducible hammertoe deformity with all soft tissue and no bone involvement, the podiatrist may perform a tenotomy to reduce the deformity, explains Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Hammertoe defined: Your toes two through five have two joints, and hammertoe is a bend in the first joint closer to the foot, says M. Dolores Farrer, DPM, MBA, wound care consultant and owner of Owner of Lagniappe Wound Care Consultants, LLC in Columbia, South Carolina. This bend results in a curled position that resembles a hammer.

Percutaneous tenotomy: When you report percutaneous tenotomies, look to the following codes:

• 28010 (Tenotomy, percutaneous, toe; single tendon). You should report 28010 when the podiatrist performs a percutaneous tenotomy with a very small incision often referred to as a stab incision over a single extensor — the top of the foot usually at the metatarsophalangeal joint (MPJ) tendon, according to Beresh.
• 28011 (Tenotomy, percutaneous, toe; multiple tendons). On the other hand, you would report 28011, when the podiatrist performs a percutaneous tenotomy to incise or divide multiple tendons in a toe through a small incision in the skin to correct the hammer toe.

Open tenotomy: For open tenotomies, you would look to the following codes:

• 28230 (Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)). This service is an open tenotomy of a single or multiple tendon of the flexor tendon(s), the bottom of the foot, Beresh explains.
• 28232 (…; toe, single tendon (separate procedure)). With this procedure, the podiatrist cuts into or through a single flexor tendon of the toe using an open incision during the performance of a more extensive procedure. Don’t miss: You should report 28232 for the division of a tendon on the toe, not the foot, through an open incision. You may report 28232 for each specific flexor tendon. However, you should always follow your payer’s instructions to document multiple units using modifiers such as 59 (Distinct procedural service) or TA – T9 modifiers that identify left or right foot, and great toe through fifth digit, if appropriate.
• 28234 (Tenotomy, open, extensor, foot or toe, each tendon). The podiatrist performs an open tenotomy of an extensor tendon of the foot or toe during this procedure. Don’t report 28234 in addition to 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)), since the total hammertoe procedure includes an extensor tenotomy.

Don’t Report Tenotomy Separately in This Case

In some cases, your podiatrist may perform an all-inclusive corrective hammertoe surgery, which includes a tenotomy. So, in these situations, you wouldn’t report the tenotomy separately.

Coding Scenario: For example, the podiatrist diagnoses the patient with right-footed, acquired, rigid hammertoe — M20.41 (Other hammer toe(s) (acquired), right foot). The podiatrist then performs a hammertoe correction via total phalangectomy and a capsulotomy for one joint with tenorrhaphy. For this procedure, you would report 28285.

During a 28285 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.

“Most times the head of the proximal phalynx is removed,” according to Beresh. “The toe is not always fused with a K-wire. There are now many different implants to be used between the proximal and middle phalynx,” he adds.

Exception: If the podiatrist were to perform a hammertoe procedure (28285) at the hallux interphalangeal joint (IPJ), and he still found contracture of the toe at the MPJ, he may then choose to release the extensor tendon through a second incision at the MPJ. You would also report 28010 for this service, according to Beresh.