Podiatry Coding & Billing Alert

Question: My podiatrist performed correction/arthroplasty on the first, second, third, and fourth right toes and all five left toes for a patient with a painful hammertoe deformity. My podiatrist also performed a bilateral ostectomy of the fifth metatarsal heads and a bilateral ostectomy of the great toes. Can you help me with the correct CPT^® codes and modifiers for this claim? I have no idea where to start.

Maine Subscriber

Answer: You should report the following codes on separate lines with the appropriate modifiers:

• 28288 (Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head) with modifier TA (Left foot, great toe) appended.
• 28288 with modifier T5 (Right foot, great toe) appended.
• 28124 (Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe) with modifier 50 (Bilateral procedure) appended.
• 28285 (Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)) with modifiers 50, 59 (Distinct procedural service), and T5 (Right foot, great toe) appended.
• 28285 with modifier T6 (Right foot, second digit) appended.
• 28285 with modifier T7 (Right foot, third digit) appended.
• 28285 with modifier T8 (Right foot, fourth digit) appended.
• 28285 with modifier T4 (Left foot, fifth digit) appended.

Caution: Some payers may require modifier 51 (Multiple procedures) appended to 28285 in addition to the anatomical modifier. You should always check with your payers to see if modifier 51 is necessary before filing 28285 twice on any claim.