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Thread: 28285? - I have a surgical case where the provider

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    Apr 2007
    New Port Richey & Gulf to Bay

    Question 28285? - I have a surgical case where the provider

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    I have a surgical case where the provider performed an arthrodesis of the DIP joint of the second toe on the left foot. Place of service is an ambulatory surgery center. The head of the middle phalanx was exposed and resected in toto. After, the corresponding base was denuded and drill holes were inserted for placement of a pin. It sounds like a hammertoe correction, but the diagnosis for this digit was not a hammertoe. Since it was not performed on the big toe, 28755 wouldn't be applicable. The patient has severe degenerative osteoarthritis.

    My question is this, if something says it is for a hammer toe correction or bunionectomy within the code description, can you use it for another diagnosis? If the procedure performed matches the description of the CPT code (aside from the diagnostic statement), would you resort to trying to find another code or use an unlisted CPT? If someone could provide documentation packing their answer that would be greatly appreciated.

    Thank you for your help.

    Respectfully Yours,

    Kevin P. Honig, CPC
    Last edited by ank3t; 10-06-2016 at 06:39 AM.

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