Wiki Mallet toe vs. Hammertoe

[gabetteyoung@yahoo.com]

I am coding a mallet toe correction. The CPT code I am using is 28285-TA. The diagnosis code I have is M20.5X2 (Other deformities of toe(s) (acquired), left foot. My billing office sent it back to me saying that 28285 is failing medical necessity. I don't see another CPT code that sounds correct, so is it a problem with my ICD-10-CM code? Can mallet toe be coded as hammertoe? Any advice would be appreciated!

 

[podcoder70]

The consensus is that 28285 covers hammer, claw, and mallet. I think it was the diagnosis code you used. The codes that are covered are:

M20.4-	-	Other hammer toe(s) (acquired)
Q66.89	-	Other specified congenital deformities of feet

 

[gabetteyoung@yahoo.com]

The consensus is that 28285 covers hammer, claw, and mallet. I think it was the diagnosis code you used. The codes that are covered are:

M20.4-	-	Other hammer toe(s) (acquired)
Q66.89	-	Other specified congenital deformities of feet

Thank you for your response! It is greatly appreciated.

 

[amyjph]

How was the mallet toe corrected? If it was a soft tissue procedure only (no bony work) check 28313. Agree as above though, if fusion, pins, bony work phalangectomy it is 28285. 28285 covers hammertoe deformity (also called claw toe, mallet toe). I would lean towards M20.5X__ too thought but I guess you could use M20.4__

Dx ranges seen for mallet:

M20.40 - M20.42	Other hammer toe(s) (acquired)
M20.5x1 - M20.62	Other and acquired anomalies of toes [hammer toe, congenital]

What reference are they using to tell you it is failing med. nec?

 

[gabetteyoung@yahoo.com]

How was the mallet toe corrected? If it was a soft tissue procedure only (no bony work) check 28313. Agree as above though, if fusion, pins, bony work phalangectomy it is 28285. 28285 covers hammertoe deformity (also called claw toe, mallet toe). I would lean towards M20.5X__ too thought but I guess you could use M20.4__

Dx ranges seen for mallet:

M20.40 - M20.42	Other hammer toe(s) (acquired)
M20.5x1 - M20.62	Other and acquired anomalies of toes [hammer toe, congenital]

What reference are they using to tell you it is failing med. nec?

So sorry I haven't seen this reply before now...not sure why I didn't. There was a phalangectomy, so I think the CPT 28285 is correct. Evidently, it kicked out in SSI, but I believe that edit was an error of some sort on their end. I left the dx as M20.5X_ and the CPT and 28285, and as far as I know there hasn't been any other problems with it. Thanks so much for your reply!