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The procedure described by CPT® Code 28020 refers to an arthrotomy, which is a surgical operation involving the opening of a joint. This specific code pertains to the intertarsal or tarsometatarsal joints, which are located in the foot. The intertarsal joints consist of the articulations between the seven tarsal bones: the talus, calcaneus, cuboid, navicular, and three cuneiform bones. The tarsometatarsal joints are formed where the cuboid and cuneiform bones connect with the metatarsal bones. An arthrotomy may be indicated for various reasons, including the exploration of the joint, drainage of fluid, or removal of loose or foreign bodies that may be causing pain or dysfunction. During the procedure, the surgeon will make an incision to access the joint capsule, which is the protective covering surrounding the joint. Once the joint capsule is exposed, it is opened to allow for direct visualization and intervention. If there is an infection present, the surgeon will drain any accumulated fluid, which may include blood and pus. Cultures may be taken for laboratory analysis to identify any infectious agents. The joint is then thoroughly flushed with saline to clear out debris and any remaining foreign materials. If any foreign bodies are identified, they are carefully removed. After the necessary interventions are completed, the joint may be drained if needed, and the incision is closed in layers to promote proper healing. A dressing is then applied to protect the surgical site. It is important to use the correct CPT® code based on the specific joint being treated, with 28020 designated for intertarsal or tarsometatarsal joints, while other codes are available for different joints in the foot.
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The procedure described by CPT® Code 28020 is indicated for various conditions affecting the intertarsal or tarsometatarsal joints. These indications may include:
The arthrotomy procedure for CPT® Code 28020 involves several critical steps to ensure effective treatment of the joint condition. The steps are as follows:
After the arthrotomy procedure, patients can expect specific post-operative care and considerations. The surgical site will need to be monitored for signs of infection, such as increased redness, swelling, or discharge. Patients may be advised to keep the area clean and dry, and to follow any specific instructions regarding dressing changes. Pain management may be necessary, and the healthcare provider may prescribe medications to help alleviate discomfort. The use of a drain, if placed, will require monitoring to ensure it is functioning properly and to prevent fluid accumulation. Follow-up appointments will be necessary to assess healing and to remove any sutures or drains as appropriate. Patients should also be informed about activity restrictions to promote optimal recovery and prevent complications.
| Short Descr | EXPLORATION OF FOOT JOINT | Medium Descr | ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT | Long Descr | Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint | 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) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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) | P3D - Major procedure, orthopedic - other | MUE | 2 | CCS Clinical Classification | 162 - Other OR therapeutic procedures on joints |
This is a primary code that can be used with these additional add-on codes.
| 20700 | Add-on Code MPFS Status: Active Code APC N ASC N1 Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure) | 20704 | Add-on Code MPFS Status: Active Code APC N Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) | 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) |
| 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. | 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). | 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. | 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. | 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. | 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.) | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | T2 | Left foot, third digit | T5 | Right foot, great toe | T6 | Right foot, second digit | T8 | Right foot, fourth digit | T9 | Right foot, fifth digit | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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