“My patient suffered blunt trauma to his right hallux and suffered non-displaced fractures of the distal and proximal phalanx. We are going to treat this injury conservatively. Would it be appropriate to bill CPT 28490 two times to represent the treatment of both phalanx?”
So, a patient suffered two non-displaced fractures affecting the right great toe. Both the distal and proximal phalanges were fractured. Conservative care was provided. How should this be coded?
Well, first of all conservative care needs to be defined. It would be best if the fractures were immobilized to allow normal bone healing to take place at the fracture sites. Examples would be the following: The hallux was splinted to the 2nd toe. The patient was placed in a surgical shoe. Would this treatment be different whether one or both phalanges were fractured? Obviously not.
CPT code 28490 is defined as: Closed treatment of fracture great toe, phalanx or phalanges; without manipulation. The definition states “phalanx or phalanges.” Based upon this premise it would be inappropriate to bill CPT code 28490 more than one time.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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