Disagree with both coding choices above.
My opinion on the CPT:
28299 RT (some payers want T5 Right foot, great toe, but you're technically only supposed to use the T mods on phalanges) (If provider disagrees code 28297)
28285 T6 (59 mod depending on payer, possibly use XS mod. However, the T6 Right foot, second digit indicates anatomic specificity but in the real world it will deny without the 59)
28313 T6 (59 mod depending on payer, possibly use XS mod)
Why?
This procedure was a combination of two hallux valgus corrections: osteotomy and arthodesis. I can see why the two choices above have the codes they do but they are not correct. The first example is trying to use individual codes when there are more specific and unbundling codes. The second suggestion is close but not correct. 28308 is
other than 1st
metatarsal. The osteotomy done in this case was on the 1st proximal phalanx.
Per CPT 28299 is reported when combined methods are used. On page two of the op report the tendons are freed, ligaments transected and MTP capsulotomy performed. Then, the arthrodesis of the metatarsocuneiform is performed (which if performed alone would be 28297). On page three it is indicated there is still hallux abductus so proximal phalanx osteotomy of the RT great is done (this would be 28298 if done alone). Because it was a combo technique you code to 28299. I know it sounds crazy because the CPT 28299 description says double osteotomy, but it's because it was a combo of two techniques. If the provider doesn't agree I would just use 28297.
On page three the provider then moves to the second toe. Plantar plate repair is always a debated procedure. I have seen unlisted, 28313, 28270, 28272, etc. among the codes used. I feel it depends on the method and other procedures at the same area. This is a well presented plantar plate reference:
https://www.apma.org/files/7 NYCC20 Coding Plantar Plate Repair SA.pdf
28285 hammertoe correction was performed on page three by K-wire throught he intermediate and distal phalanges and I would argue that is a different anatomic area than the plantar plate (28313) repair done at the second MTP joint.
You may find a payer denial of either the 28313 or 28285 as inclusive. Be sure to assign different diagnoses to each procedure and don't overlap them.
76000 is included because it has separate procedure designation meaning it is integral to these others and can't be reported separately (even with a 59 that's a red flag). It's also explained in the NCCI manual under "medical surgical package". The PRP placement is also included when used to promote healing at the site of a greater procedure. The "stuff" like the PRP kit would be a facility supply.
