Wiki Billing for two hammertoe repairs on one toe?

[skpartiss]

I have a question about billing 28285 twice on the same toe. The doctor insists that if he performs the repair on both the DIP joint and the PIP joint that he can bill 28285 twice. I don't agree but cannot find any information to justify this! Any ideas?

 

[PLAIDMAN]

The definition for Hammertoe I have "hammertoe is hyperextension of MPJ AND DIP with PIP locked in flexion" so the very definition includes deformity of the DIP.

So I find my answer right in the CPT code "correction hammerTOE"- correction of the defomity of the toe. It does not say correction of a hammering joint, other codes you might charge more than once on one extremity say "each tendon" or "each metatarsal"

If the doc did actually have to do more work at the DIP then maybe I would put a mod 22 on it and have the doc dictate cover letter stating why he had to do more work at the DIP.

That's all I can find on this one.

 

[mitchellde]

per the CDR:
Hammertoe describes an abnormal flexion posture of the proximal interphalangeal joint of one of the lesser toes. The physician makes an elliptical incision over th proximal interphalangeal joint 5mm to 6mm wide. A portion of the extensor tendon and joint capsule under the skin is removed. The collateral ligaments are cut to allow the toe to be flexed to 90 degrees. The head and the neck of the proximal phalanx are removed with a small power blade saw and the ends of the bone are smoothed. The toe is checked for ROM and the extensor tendon is reattached and the incision is closed.

So there is no DIP involvement with a hammertoe or the repair. If your physician's note details a DIP joint repair then there may be another code you can use. Without the op note I cannot tell.

 

[DOVERRED]

try looking at 28299