Podiatry Coding & Billing Alert

Question: One of our patients received a surgical correction for a rigid hammertoe on the right foot, and there is previous documentation citing they have arthritis and have been wearing poor-fitting shoes. Should I code this as acquired even though the documentation doesn’t specifically state that as the cause? Does it need further clarification from the provider, or is that documentation sufficient to determine it’s acquired and not congenital?

Maine Subscriber

Answer: Hammertoe may be present at birth or could develop later. If the condition is congenital, the patient likely has other family members with hammertoe. Since the documented cause is arthritis and ill-fitting shoes, that supports an acquired hammertoe, but it is best to have the provider specifically document that diagnosis to prevent billing difficulties.

For this encounter, if the podiatrist performs a partial phalangectomy to correct the right hammertoe, report 28285 (Correction, hammertoe [eg, interphalangeal fusion, partial or total phalangectomy]) for the procedure and M20.41 (Other hammer toe(s) (acquired), right foot) for the diagnosis on your claim.