Orthopedic Coding Updates- The Intricate Toe Contractures


There are different kinds of toe contractures but the three major contractures or the ones that we see most commonly are the— hammertoe, the mallet toe and the claw toe. Now, the difference between these three is the location of the contracture. In the hammertoe, it is at the area of the proximal inter-phalangeal joint, where as the mallet toe is the contracture of the distal inter-phalangeal joint. And the claw toe has contractures at both the PIP joint and the metatarsal phalangeal joint. These different areas or anatomical location gives us a better idea, which helps our providers in describing these within their operative reports. And they're not using the brand name term so to speak.

The codes related to these contractures and the repairs of these contractures will be, for hammertoe you can use 28285. The mallet toe is a little bit more complicated. You can use — 28285 or 28136 and/or the 28280. FYI you can use any one of these codes to repair a mallet toe or you can use a combination of these codes. Again, it depends on the complication and complexity of the contractures and what exactly is your provider doing to perform or to correct this mallet toe. For claw toe, you can use 28285 and 28570. Why would you use that? Well, because you are not only going to release the proximal inter-phalangeal joint but also release the metatarsal phalangeal joint. So, there are two codes to represent it, as the release is in two different areas.

Hammertoe and tenotomy. As our speaker mentioned in orthopedics conference, sometimes when you are performing the correction of a hammertoe, you're also performing or your provider would be performing a tenotomy of the flexor tendon within that toe. There is a controversy in whether or not the tenotomy is included in the correction of the hammertoe or the fusion. It is not always performed so it's not a common part of a hammertoe correction and it is not a CCI edit. So there is no dispute on whether or not it's included or excluded. But some carriers say that when you're performing an incision of the tendon, the flexor tendon, that is part of a correction of the hammertoe. So, I want you to be aware of the fact that this isn't always performed. It's not a CCI edit. But there is some controversy so you may have to discuss it with you carriers as to whether or not they're going to pay these two codes together.

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