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To properly assign CPT codes to podiatry cases, coding specialists must first understand the anatomy of the foot, because many of the CPT codes specify the anatomical location of the foot in the code description.
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Physician Documentation Issues |
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A coder's knowledge of foot anatomy improves podiatry coding accuracy, but the physician's documentation is the most important element. Here are 2 common documentation deficiencies: Primary vs. Secondary Ligament Repair
"Contracted" Toe Many surgeons list "contracted toe" as the patient's diagnosis, a problem if a more specific diagnosis is more appropriate, such as hammertoe, clawtoe or joint contracture. If a contracted toe is actually a hammertoe, the coder will likely assign code 28285 [Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy)]. If, however, the contracted toe is a clawtoe, the appropriate code may be 28313 [Reconstruction, angular deformity of toe, soft tissue procedures only (e.g., overlapping second toe, 5th toe, curly toes)]. — Lolita Jones, RHIA, CCS |
Bones of the toes
There are 14 bones called phalanges located in the toes of a foot. The 1st toe (also called great toe or hallux) has a proximal phalanx and a distal phalanx. The 2nd, 3rd, 4th, and 5th toes each have 3 phalanges: proximal phalanx, middle phalanx and distal phalanx.
Some physicians refer to an entire toe as a "phalanx," so be careful when reading the operative reports to distinguish between an entire toe and 1 of the toe bones when "phalanx" is referenced. For example, if a physician dictates that the "distal phalanx of the left 3rd phalanx was removed entirely," this means that the distal phalanx bone was removed from the left 3rd toe. Code such a procedure as CPT code 28150-T2 (Phalangectomy, toe, each toe — left foot, 3rd digit).
Confirm that the OR report documentation supports the specific phalanx when it impacts the CPT code assignment. For example, if a patient has a right hallux proximal phalanx osteotomy performed, assign code 28310-T5 [Osteotomy, shortening, angular or rotational correction; proximal phalanx, 1st toe (separate procedure) — right foot, great toe].
Bones of the midfoot
There are 5 bones called metatarsals located between the proximal phalanges and the distal row of tarsal bones in the hindfoot: 1st, 2nd, 3rd, 4th and 5th metatarsals.
Don't append toe modifiers (-TA through -T9) to CPT codes that classify metatarsal surgery. Metatarsal bones are foot bones, they are not toe bones/phalanges. For example, if a patient has a "right 5th metatarsal head exostectomy" performed, assign CPT code 28288-RT (Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head — right side).
Bones of the hindfoot
There are 7 bones of the hindfoot, arranged in 2 rows. The distal row consists of the medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid and navicular bone; the proximal row consists of the talus (located at the ankle) and calcaneus (heel bone).
Be careful when assigning codes for tarsal surgery, as some of the CPT codes include or exclude specific tarsal bones. For example, if a patient undergoes a right foot navicular bone osteotomy, assign CPT code 28304-RT (Osteotomy, tarsal bones, other than calcaneus or talus). If a patient undergoes a right foot calcaneal osteotomy, assign CPT code 28300-RT [Osteotomy; calcaneus (e.g., Dwyer- or Chambers-type procedure), with or without internal fixation].
Bone anatomical sections/landmarks
Each phalanx, metatarsal and tarsal bone consists of 3 anatomical sections:
- base (also called proximal end);
- a shaft or body; and
- a head (also called distal end).
Be careful when assigning podiatry CPT codes, as some of the code descriptions specifically reference the bone anatomical landmark, such as:
- 28111 Ostectomy, complete excision; first metatarsal head.
- 28126 Resection, partial or complete, phalangeal base, each toe.
- 28153 Resection, condyle(s), distal end of phalanx, each toe.
Joints of the foot
The interphalangeal (IP) joint is located in the great toe, between the base of the distal phalanx and the head of the proximal phalanx (Note: There is no middle phalanx in the great toe/hallux/first toe).
The distal interphalangeal (DIP) joint is located in the 2nd through 5th toes, between the base of a distal phalanx and the head of a middle phalanx.
The metatarsophalangeal (MTP) joint is located in the 1st through 5th toes, between the base of a proximal phalanx and the head of a metatarsal.
The proximal interphalangeal (PIP) joint is located in the 2nd through 5th toes, between the base of a middle phalanx and the head of a proximal phalanx.
The tarsometatarsal (TMT) joint is between the base of a metatarsal and the head of a tarsal bone.
The intertarsal joint is located between 2 tarsal bones.
Be careful when assigning codes. Many codes specifically reference the joint involved for procedure:
- 28050 Arthrotomy with biopsy; intertarsal or tarsometatarsal joint.
- 28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint.
- 28755 Arthrodesis, great toe; interphalangeal joint.
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3 Improperly Coded Podiatry Cases |
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Missed CPT Codes x 2 Inappropriate CPT Code Inappropriate CPT Codes x 2 |
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