Podiatry Coding & Billing Alert
Hammer Out This Hammertoe Correction Scenario
Question: Is it appropriate to report a hammertoe correction (28285) along with a corresponding metatarsophalangeal joint capsulotomy (28270) during the same surgical encounter when both procedures are medically necessary to completely correct the presenting deformities?
Kansas Subscriber
Answer: Yes. It is not unusual to have to perform both of these procedures during the same surgical session to completely correct a complex ray deformity. You can define a hammer-toe by a digital contracture at the distal interphalangeal joint and/or proximal interphalangeal joint. A contracted metatarsophalangeal joint is a dorsiflexory positioning of the proximal phalanx on the metatarsal head. These are two distinct deformities that can and do exist in isolation, but if both conditions are present, no single CPT® code describes the correction of both deformities.
The coding would be hammertoe correction (28285, Correction, hammertoe [e.g., interphalangeal fusion, partial or total phalangectomy]) and corresponding open metatarsophalangeal joint capsulotomy with or without tenorrhaphy (28270, Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint [separate procedure]). These procedures are performed independent of one another.
Note: A percutaneous release of the joint contracture does not meet the description of code 28270. The coder should append Modifier 59 (Distinct procedural service), to the 28270 code to separately identify these procedures.
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