Bill for Correction of a Hammertoe Deformity

What is the most appropriate way(s) to bill for the correction of a hammertoe deformity?

The CPT codes involved are the following:

28108 Excision or curettage of bone cyst or benign tumor, phalanges of foot

28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g., osteomyelitis or bossing); phalanx of toe

28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)

28272 Capsulotomy; interphalangeal joint, each joint (separate procedure)

28285 Correction, hammertoe (eg. interphalangeal fusion, partial or total phalangectomy, arthroplasty) 28286 Correction, cocked-up fifth toe, with plastic skin closure (e.g., Ruiz-Mora type procedure)

28310 Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)

28312 Osteotomy, shortening, angular or rotational correction; other phalanges, any toe.

Multiple procedures performed on a single digit to correct a hammertoe deformity are usually considered a hammertoe correction and payable to a maximum 28285 code value.

A Hammertoe Correction:

1. 1. May include an excision of a portion of bone, with or without fusion or fixation of the digit, with or without a kwire or any other mode of internal fixation.

Includes all skin and soft tissue corrections, repairs, incisions, or excision at the interphalangeal joints or metatarsal phalangeal joint.

2. 2. Multiple exostectomies performed at the same time on the same toe are considered incidental and are included in the reimbursement for a hammertoe.
3. 3. A matrix correction done in addition to the hammertoe correction is usually payable at 50% of the primary procedure code. This is an example of two unrelated procedures performed on the same toe, same date of service.
4. 4. Code 14040 is usually not considered appropriate for de-rotation of the 5th toe. Most carriers will pay this procedure as 28285 or 28286. CPT code 14040 is defined as the following: Adjacent tissue transfer or rearrangement, feet; defect 10 sq. cm or less.
5. 5. Insertion of an interphalangeal implant into toes 2-5 is as part of a hammertoe correction is considered included in the 28285 reimbursement.

This is my opinion.

Michael G. Warshaw

DPM, CPC