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Official Description

Incision, bone cortex (eg, osteomyelitis or bone abscess), foot

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 28005 involves an incision into the bone cortex of the foot, specifically targeting conditions such as osteomyelitis or a bone abscess. Osteomyelitis refers to an infection of the bone, while a bone abscess is a localized collection of pus within the bone. The bones of the foot include various structures such as the tarsals, metatarsals, and the proximal, middle, and distal phalanges. During this surgical intervention, an incision is made through the skin and soft tissue to access the infected area of the bone. The periosteum, which is the dense layer of vascular connective tissue enveloping the bones, is carefully elevated to expose the underlying cortical bone. A small section, or button, of the cortical bone is then removed to access the bone marrow, which is crucial for alleviating pressure caused by inflammation and preventing further restriction of blood flow to the affected area. If pus is present, the initial incision may be enlarged using specialized instruments such as a chisel or gouge, allowing for better drainage and treatment of the infection. In cases where the epiphysis, the end part of a long bone, is involved, a portion of the epiphyseal cortex may also be excised to ensure complete drainage of the abscess. This procedure is essential for managing severe bone infections and facilitating recovery by addressing the underlying issues within the bone structure.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 28005 is indicated for specific conditions affecting the bones of the foot. These include:

  • Osteomyelitis - A serious infection of the bone that can lead to bone destruction and necrosis if not treated promptly.
  • Bone Abscess - A localized collection of pus within the bone, often resulting from infection, which can cause significant pain and swelling.

2. Procedure

The procedure involves several critical steps to effectively treat the infected bone. These steps include:

  • Incision - An incision is made in the skin over the area of the infected bone, allowing access to the underlying soft tissue and bone structure.
  • Elevation of the Periosteum - The periosteum, a protective layer surrounding the bone, is carefully elevated to expose the cortical bone beneath it, ensuring that the surgical site is adequately prepared for further intervention.
  • Removal of Cortical Bone Button - A small button of cortical bone is excised to access the bone marrow. This step is crucial for relieving pressure caused by inflammation and facilitating drainage of any infectious material.
  • Exposure of Bone Marrow - By removing the cortical bone, the underlying bone marrow is exposed, which is essential for addressing the infection and restoring normal blood flow to the area.
  • Enlargement of the Incision (if necessary) - If pus is encountered during the procedure, the initial incision may be enlarged using a chisel or gouge, extending along the bone for one to two inches to ensure thorough drainage of the abscess.
  • Removal of Epiphyseal Cortex (if involved) - In cases where the epiphysis is affected, a section of the epiphyseal cortex may be removed to facilitate complete drainage and treatment of the infection.

3. Post-Procedure

After the procedure, appropriate post-operative care is essential for recovery. This may include monitoring for signs of infection, managing pain, and ensuring proper wound care to promote healing. Patients may require follow-up visits to assess the surgical site and confirm that the infection has been adequately addressed. Rehabilitation may also be necessary to restore function and mobility in the affected foot.

Short Descr TREAT FOOT BONE LESION
Medium Descr INCISION BONE CORTEX FOOT
Long Descr Incision, bone cortex (eg, osteomyelitis or bone abscess), foot
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5B - Ambulatory procedures - musculoskeletal
MUE 3
CCS Clinical Classification 161 - Other OR therapeutic procedures on bone
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AF Specialty physician
AG Primary physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CG Policy criteria applied
ET Emergency services
F8 Right hand, fourth digit
F9 Right hand, fifth digit
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SG Ambulatory surgical center (asc) facility service
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
TA Left foot, great toe
TL Early intervention/individualized family service plan (ifsp)
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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Pre-1990 Added Code added.
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