# Help with hammertoe surgery



## VoitChromy (Feb 13, 2016)

I have been asked to help with a surgical denial that a co-worker coded. She is on vacation and I need  help before she returns. 

My co- worker coded as follows

28285 T1- Correction Hammertoe  interphalangeal fusion
28285 XS T2
28285 XS T3
28285 XS T4
28270 XU T1- Capsulotomy; metatarsophalangeal joint
28270 XU T2
28270 XU T3
28270 XU T4
28052 XU T1Arthrotomy with biopsy; metatarsophalangeal joint
                  In this procedure, the provider makes an incision to open the metatarsophalangeal joint, where the foot and toe join, and takes a biopsy of the soft tissue. 
28052 XU T2
28052 XU T3
28052 XU T4

 All codes except the 28052's were paid. Medicare denied all four of the 28052 procedures stating that the payor deems the information submitted does not support this many/frequency of services. I do see that 28052 is bundled with the 28270

I do not believe that 28052 was the appropriate code: no where does the surgeon state a biopsy was taken.
I have also been told-  multiple procedure performed on a single digit are usually considered a Hammertoe correction and payable to a maximum of  code value. 28285.  Can anyone help me? Should there be another code billed? or is this payable only to the Hammertoe correction?


Preoperative diagnosis: painful hammertoes of left second, third, forth and fifth

Operations performed:
1. Arthrodesis of proximal interphalangeal joint, left second, third, forth and fifth toes
2. Arthroplasty of proximal interphalangeal joint left fifth toe middle phalanx for arth
3. Metatarsophalangeal joint release  left second, third, forth and fifth toes
4. Extensor tendon lenthening left second, third, forth and fifth toes

Description of procedure:

Attention was directed to the dorsal aspect of the left second toe where a linear longitudinal incision was made. The incision was deepened through the subcutanious tissues utilizing sharp and blunt dissection. Care was taken to identify and retract all vital, neural vascular structures. At this time a tenotomy and capulotomy was performed of the proximal interphalangeal joint. The extensor tendon was then extended, reflected proximally to the level of the metatarsophalangeal joint. Next as oscillating bone saw was utilized to resect the head of the proximal phalanx and the base of the middle phalanx for arthrodesis at the proximal interphalangeal joint. Attention was then redirected to the metatarsophalangeal joint where contraction of the toe was noted to still be evident. A metatarsophalangeal joint release was performed and a McGlamry elevator was utilized to reduce the contracture of the metatarsophalangeal joint, which was noted to be excellent. Next due to the severe contacture of the toe an extensor tendon lengthening was required in order to achieve closure and reapproximation of the extensor tendon, a Z-type lengthening was performed. Next a 0.62 K-wire was then retrograded through the middle phalanx to the end of the second toe and then advanced into the proximal phalanx into the second metatarsal crossing the metatarsophalangeal joint. The toe was noted to be in an excellent position at this point. The attention was then directed to the third toe where the an identical procedure was performed. An Arthrodesis was performed at the  proximal interphalangeal joint and metatarsophalangeal joint release as well as an extensor tendon lengthening. The attention was then directed to the forth toe where the identical procedure was performed. An Arthrodesis was performed at the  proximal interphalangeal joint and metatarsophalangeal joint release as well as an extensor tendon lengthening. The attention was then directed to the left fifth toe where the an identical procedure was performed. An Arthrodesis was performed at the  proximal interphalangeal joint and metatarsophalangeal joint release as well as an extensor tendon lengthening. 


Thanks in advance for any help


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## nsteinhauser (Feb 16, 2016)

From an old AAOS bulletin: 
Hammertoes
Hammertoe corrections are reported with CPT code 28285. The AAOS Complete Guide to Global Service Data, (2003 edition) states the following procedures would be considered/included in the reporting of 28285:
•	Arthrotomy (eg 28022)
•	Extensor tenotomy and repair (eg 28208, 28234)
•	Capsulotomy for joint contracture (eg 28272)
•	Synovial biopsy (eg 28054)
•	Internal fixation (eg 28675)
•	Implant insertion 
•	Excision of exostosis (eg 28124)
•	Excision of skin lesion (eg 11420-11426)
•	Hemiphalangectomy (eg 28126, 28160)
•	Local bone graft
•	Phalangectomy (eg 28150)

I'm not certain what code is appropriate for an extensor tendon lengthening but I'm thinking the 28234 (not the 28052).  According to the AAOS, it is included in the 28285.
Hope this helps.


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## VoitChromy (Feb 19, 2016)

Thanks so much very helpful information


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