# Closed tx of phalangeal fx



## Krzysztof (Mar 4, 2009)

Good Day,

I am seeking your feedback on the proper use of CPT code 28510 (Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each).

The lay description further describes this procedure: "The physician treats a fracture of one of the four toes other than the big toe. No open surgery or manipulation of the toe or foot is required. X-rays (reported separately) of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physician applies a splint, brace, or cast to the toe and foot."

Now, in the case of an encounter during which the pt is dx'd w/ phalangeal fx (confirmed via x-ray), but in the *absence* of supportive device application, is this code appropriate? One colleague argues that the encounter should be coded as E/M + rad, at most... whereas another colleague argues that the mention of "splint, brace, or cast" application in the lay description does not set a requirement... therefore making CPT code 28510 appropriate.

Thanks in advance!


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## Anna Weaver (Mar 4, 2009)

*toe fx*

According to Coding Companion 2009 by Ingenix Ortho-lower hips and below page 438:
28510-28515
"In 28510, separately reportable x-rays of the toe confirm a fracture or fractures of the bones where the fragments are in an acceptable position. The physician applies a splint, brace, or cast to the toe and foot."

Coding tips:
This procedure may be reported multiple times as it is reported for each closed treatment of a phalangeal fracture performed.

I take this to mean that there must be some treatment, other than buddy taping required. (cast, splint, or brace)

My opinion!!


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## Krzysztof (Mar 5, 2009)

Thank you for providing your opinion, Anna.  I truly appreciate it.

Anyone else care to weigh in for a majority consensus?


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## dragonflye (Mar 9, 2009)

I agree with Anna,

Unless you did something other than buddy taping you can not use the code.  You must use a cast, splint or other supply.


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## JDACPC (Apr 22, 2009)

It's nice we all see the same type issues...

It is being argued that "buddy taping" of a toe equals a brace and "every ortho (doc)knows that."  I need back up in black and white as to the validity of that.  I tend to think not since there is a code for taping/strapping (29550).  Can anyone help prove me right?  Even wrong, I don't mind!


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