“In many cases requiring an arthroplasty of the proximal interphalangeal joint (PIPJ) 5th digit (especially when associated with a heloma molle), I often do an arthroplasty PIPJ, flexor lengthening and a partial syndactylization (advancing the webspace but differently than the description of Ruiz-Mora). I have always simply billed for an arthroplasty PIPJ 5th toe. Now I have been forced to pay attention to coding because of my EMR program. Should I have been billing this differently for all these years?”
So, a patient had an arthroplasty performed at the PIPJ of the 5th toe in addition to a flexor tendon lengthening and a partial syndactylization. How should this be coded?
The arthroplasty is coded using CPT 28285 which is defined as the following: Correction, hammertoe (e.g. interphalangeal fusion, partial or total phalangectomy).
The flexor tendon lengthening is coded using CPT 28232 which is defined as the following: Tenotomy, open, tendon flexor; toe, single tendon (separate procedure).
The partial syndactylization, advancing the webspace is best coded using CPT 14040 which is defined as the following: Adjacent tissue transfer or rearrangement, feet; defect 10 sq. cm or less
The first step that needs to be taken is to access the NCCI edits. CPT 28232 and CPT 14040 are both Column 2 codes to CPT 28285 the Column 1 code within the NCCI edits. Therefore, based upon the posted scenario, neither CPT 28232 nor CPT 14040 are separately reimbursable when billed in conjunction with CPT 28285. CPT 28286 is not an option. It is defined as the following: Correction, cock-up fifth toe, with plastic skin closure (e.g. (Ruiz-Mora type procedure). Clearly, this was not the pathology that needed to be corrected, nor was it the procedure that was actually performed. The only option for the correct coding for the surgical correction that was performed on the 5th toe is the following:
CPT 28285 – T4/T9
This is my opinion.
Michael G. Warshaw, DPM, CPC
Terrific NEWS!!!
THE 2025 PODIATRY CODING MANUAL IS NOW AVAILABLE in either Book or Flash-drive formats. It has been completely updated for the calendar year 2025 including the NEW policy for the application of skin substitutes that goes into effect February 12, 2025. Many offices across the country consider this to be their “Bible” when it comes to coding, billing, and documentation. The price is still only $125 including shipping! To purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for $125 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757
Read Comments