Orthopedic Coding Alert

Question: Which CPT code should I report when the surgeon documents treating mallet toe with an open flexor tenotomy at the plantar aspect of the proximal interphalangeal joint (PIPJ)? Maryland Subscriber Answer: CPT offers several foot and toe tenotomy codes, but you can choose the proper one by breaking down the elements of the procedure you describe. You note that the procedure is open, so you can eliminate percutaneous codes 28010 (Tenotomy, percutaneous, toe; single tendon) and 28011 (- multiple tendons). The procedure involves the flexor tendon, so you can also eliminate extensor code 28234 (Tenotomy, open, extensor, foot or toe, each tendon). You don't mention lengthening or releasing the abductor hallucis muscle, so 28240 (Tenotomy, lengthening, or release, abductor hallucis muscle) is out. That leaves you with 28230 (Tenotomy, open, tendon flexor; foot, single or multiple tendon[s] [separate procedure]) and 28232 (- toe, single tendon [separate procedure]). The surgeon only addressed one tendon and one toe, so you should report 28232.