Podiatry Coding & Billing Alert

Question: A patient came into the office with a “rigid mallet toe” in right foot second toe. During the examination, the physician also noticed a bunion on the first toe. The podiatrist performed the corrections with arthroplasty for the mallet toe and bunionectomy in one sitting. How should I code this encounter? Can I separately code these two procedures or are they bundled?

North Dakota Subscriber

Answer: The most common technique that is used is a DuVries arthroplasty done at the distal interphalangeal joint (DIPJ), often accompanied by a flexor digitorum longus tenotomy done through the same incision. You should code this with 28285 (Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]). You can separately code for the flexor tendon release using 28232 (Tenotomy, open, tendon flexor; toe, single tendon [separate procedure]). 

Caution: The Correct Coding Initiative (CCI) bundles extensor tenotomy (28234, Tenotomy, open, extensor, foot or toe, each tendon) into 28285. Although CCI doesn’t bundle flexor tenotomy 28232 into 28285, you may face payer denials for flexor tenotomy claims as payers may refuse to accept the flexor tenotomy as a separate and consider the work performed doing the tenotomy as included in 28285.

Some surgeons perform a partial resection of the lesser toe base’s proximal phalanx to further improve residual deformity. If your surgeon performs this procedure, you can report 28126 (Resection, partial or complete, phalangeal base, each toe).

If absolutely necessary, the toe can often be stabilized with the use of a partial proximal syndactylization to the adjacent toe, for which you can report 28280 (Syndactylization, toes [e.g., webbing or Kelikian type procedure]). The surgeon may use a syndactylization any time an operated toe appears too floppy. Another option is amputation of the distal phalanx. 

You can report the bunionectomy with code 28296 (Correction, hallux valgus [bunion], with or without sesamoidectomy; with metatarsal osteotomy [eg, Mitchell, Chevron, or concentric type procedures]). A hallux valgus correction surgical procedure on the first metatarsal and a bunion procedure on the second toe are separately reportable although many payers may bundle them together.

A hammertoe repair (CPT® code 28285) is not included as a bundled procedure to a hallux valgus correction procedure. However, according to Medicare CCI edits, you will have to attach appropriate modifier(s) 59 (or the new EPSU modifiers) and the T modifier to specify that the procedures are distinct and separate from each other. You should check the local payer rules for the exact modifier rules.

In your case you should code:

• 28296-T5
• 28285-XS, T6.