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Closed tx of phalangeal fx

  1. #1
    Charlotte, NC
    Question Closed tx of phalangeal fx
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    Good Day,

    I am seeking your feedback on the proper use of CPT code 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each).

    The lay description further describes this procedure: "The physician treats a fracture of one of the four toes other than the big toe. No open surgery or manipulation of the toe or foot is required. X-rays (reported separately) of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physician applies a splint, brace, or cast to the toe and foot."

    Now, in the case of an encounter during which the pt is dx'd w/ phalangeal fx (confirmed via x-ray), but in the absence of supportive device application, is this code appropriate? One colleague argues that the encounter should be coded as E/M + rad, at most... whereas another colleague argues that the mention of "splint, brace, or cast" application in the lay description does not set a requirement... therefore making CPT code 28510 appropriate.

    Thanks in advance!

  2. #2
    Default toe fx
    According to Coding Companion 2009 by Ingenix Ortho-lower hips and below page 438:
    "In 28510, separately reportable x-rays of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physician applies a splint, brace, or cast to the toe and foot."

    Coding tips:
    This procedure may be reported multiple times as it is reported for each closed treatment of a phalangeal fracture performed.

    I take this to mean that there must be some treatment, other than buddy taping required. (cast, splint, or brace)

    My opinion!!

  3. #3
    Charlotte, NC
    Thank you for providing your opinion, Anna. I truly appreciate it.

    Anyone else care to weigh in for a majority consensus?

  4. #4
    I agree with Anna,

    Unless you did something other than buddy taping you can not use the code. You must use a cast, splint or other supply.

  5. #5
    It's nice we all see the same type issues...

    It is being argued that "buddy taping" of a toe equals a brace and "every ortho (doc)knows that." I need back up in black and white as to the validity of that. I tend to think not since there is a code for taping/strapping (29550). Can anyone help prove me right? Even wrong, I don't mind!

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