Wiki PIP dislocation and bill Hammertoe code?

[Orthocoderpgu]

Patient has a dislocation of the PIP joint on the toe. Doc does an implant for fusion was inserted to keep the toe in place. Here is what I don't understand. My doc wants to bill the "Hammertoe" code as well 28285. No where in the documentation does it state that the patient has hammertoe. So I am not sure about billing this code too. Any thoughts? I can see the insurance denying the hammertoe procedure if it's billed with the dislocation code. And I can't see billing the hammertoe diagnosis since that has never been documented.

 

[klamond]

The description for 28285 is correction ,hammertoe (eg, interphalangeal fusion, partial or total phalangectomy). In my opinion, since he performed a PIP fusion, you should be able to use this code for a dislocation or not. You may be able to use modifier 22 with a letter attached showing "greater than that usually required" work or effort was put into performing the interphalangeal fusion with the implant if the documentation shows this.