Wiki lesser toe arthrodesis CPT 28285 versus unlisted 28899

[swallace1]

Patient seen by MD for left 5th toe middle phalanx fracture, post 6 months. Procedure performed: Left fifth toe distal IP joint arthrodesis.

MD wants to assign 28285 since it is similar. Coder wants to assign Unlisted 28899. If we bill with CPT 28285 with a fracture code diagnosis, I fear the claim will be denied—the other option is to bill with unlisted CPT with comparison to CPT 28285.

Any suggestions greatly, appreciated.

OP note documents " I then utilized a combination of the Freer elevator as well as the minimally invasive elevator to mobilize this joint. I then inserted the Arthrex minimally invasive 2-mm x 8-mm bur into the distal interphalangeal joint and used this to prep the distal aspect of the middle phalanx and the proximal aspect of the distal phalanx. Once this was done, I was able to reduce the deformity and align the toe. I then placed a 0.062 K-wire retrograde across the distal interphalangeal joint and the proximal interphalangeal joint."

 

[NRaizman]

A fracture can cause a hammer toe deformity. 28285 is an appropriate code for lesser toe fusion or deformity. One strategy is to make sure the documentation notes the deformity is present secondary to a fracture and add a diagnosis for hammertoe if it gets kicked back.

28525 is even better as a code for this. You are doing open treatment of a fracture, and you clearly already have a fracture diagnosis code. The fact that, as a result of the fracture, you were forced to fuse the joint, is not particularly relevant. The two codes have identical RV values

Either way, using an unlisted code is a great way to create a lot more work for yourselves and not get reimbursed for anything.