# Hammertoe repair and a flexor tenotomy



## seslinger

Hi, I was wondering if it is appropriate to bill a hammertoe repair 28285 and a percutaneous flexor tenotomy 28010 of the same toe?  I looked and Medicare bundles but I can use the -59 but not sure if they are considered incidental? 
Thank you.


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## mbort

did they really do it percutaneously?  I would have to see the op note in order to determine if its incidental, more than likely it is though.


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## seslinger

Here is the body of the op note " incision was made down to the level of the tendon.  The tendon was trasected and reflected proximally and distally taking care to preserve all neurovascular structures.  No other hemostasis was performed.  A bone cutter was then used to resect the head of the proximal phalanx and rasp smooth with the bell rasp.  Attention was then directed to the plantar aspect of the digit, which is still noted to be slightly contracted at this level due to a tight flexor tendon and flexor tenotomy percutaneously was performed at this time. A small section of the tendon was also transected for additional correction and shortening."

thank you.


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## mbort

I dont like this dictator!!  lol

He/she only states "flexor tenotomy percutaneously was performed".  He/she really needs to tell us how this was accomplished.  Simply stating they did it, doesnt justify that it was done.  

The codes 28010 and 28232 are so close with the exception of the word percutaneous.  

What I would do is..query the doc.  Make him give you more information.  Because he also mentions transecting some of the tendon, I would lean more towards the open code...but he has that nasty perc word in there that throws us.

Once you gethim to document his incision, depth and how it was performed, you should be able to make an educated decision on whether or not the 59 wouldbe justified if you end up using 28010.  28232 does not bundle and would not require it.

Mary,CPC,COSC


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## seslinger

thank you I will go back to her.


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