“I have a patient with a hereditary floating 2nd toe, secondary to joint instability and contracture of the extensor tendon and capsular tissue. I have decided that the most appropriate surgical procedures for the correction of this situation are a V-Y skin-plasty and an extensor tendon lengthening and are coded with CPT code 14040 and CPT code 28234, respectively. However, the ICD code M20.5×2 (Other deformities of toe(s) (acquired), left foot) does not seem to be listed as a potential diagnosis for the above CPT codes. Please help!”
CPT code 14040 is: Adjacent tissue transfer or rearrangement, feet; defect 10 sq. cm or less.
CPT code 28234 is: Tenotomy, open, extensor, foot or toe, each tendon.
CPT codes 14040 and 28234 are not bundled per the CCI edits, thus they are both separately reimbursable when they are performed and billed together. The problem is that when the Diagnosis to Procedure Linkage is accessed, ICD-10-CM code M20.5X2 (Other deformities of toe(s) (acquired), left foot is not listed as an ICD-10-CM code that is linked to CPT code 14040, but is listed as an ICD-10-CM code that is linked to CPT code 28234. The ICD-10-CM codes that are linked to ICD-10-CM code 14040 are diagnosis codes for wounds, injuries, burns, etc. In other words, they are ICD-10-CM codes that are listed in Chapter 19 in the ICD-10-CM Manual: Injury, Poisoning, and Certain Other Consequences of External Causes (S00 – T88).
So what can be done? In reality, isn’t a “floating 2nd toe, secondary to joint instability and contracture of the extensor tendon and capsular tissue” a hammertoe? Aren’t CPT codes 14040 and 28234 soft tissue procedures without evidence of any osseous involvement? Of course they are!
My suggestion is the following: I would bill CPT code 28313: Reconstruction, angular deformity of toe, soft tissue procedures only (eg. overlapping 2nd toe, fifth toe, curly toes). I would link ICD-10-CM code M20.42 (Other hammertoe(s) (acquired), left foot to CPT code 28313. This should get you paid.
This is my opinion.
Dr. Michael G. Warshaw
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