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The procedure described by CPT® Code 28112 refers to the complete excision of the metatarsal head, specifically for the second, third, or fourth metatarsals. This surgical intervention is typically indicated for the treatment of bony overgrowths that occur at the metatarsal heads, which can lead to pain and functional impairment. The procedure involves making a longitudinal or lazy-S incision on the dorsal aspect of the affected metatarsal head to access the underlying structures. During the surgery, care is taken to dissect the soft tissues while protecting the superficial blood vessels to minimize complications. The long extensor tendons are identified, detached, and may be transferred as necessary to ensure proper joint function post-surgery. The joint capsule is incised, allowing for the creation of a capsular flap, which facilitates the complete exposure and excision of the metatarsal head while preserving the phalangeal base. To stabilize the joint after excision, a Kirschner wire is inserted through the proximal phalanx into the metatarsal medullary canal. Finally, any excess joint capsule is either excised or plicated, and the overlying soft tissues are meticulously closed in layers to promote optimal healing. This procedure is distinct from similar codes, such as CPT® 28111, which pertains to the complete excision of the first metatarsal head, and CPT® 28113, which is for the fifth metatarsal head.
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The procedure indicated by CPT® Code 28112 is performed for specific conditions related to the metatarsal heads. The following are the explicitly provided indications for this surgical intervention:
The procedure for CPT® Code 28112 involves several detailed steps to ensure the complete excision of the metatarsal head. The following procedural steps are outlined:
After the completion of the procedure, patients can expect specific post-operative care and considerations. It is important to monitor the surgical site for any signs of infection or complications. Patients may be advised to keep the foot elevated to reduce swelling and to follow specific weight-bearing restrictions as determined by the surgeon. Pain management strategies will be discussed, and follow-up appointments will be scheduled to assess healing and the stability of the joint. Rehabilitation exercises may also be introduced gradually to restore function and strength to the foot.
| Short Descr | PART REMOVAL OF METATARSAL | Medium Descr | OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4 | Long Descr | Ostectomy, complete excision; other metatarsal head (second, third or fourth) | 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) | 1 - 150% payment adjustment for bilateral procedures applies. | 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) | P5B - Ambulatory procedures - musculoskeletal | MUE | 4 | CCS Clinical Classification | 142 - Partial excision bone |
| 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). | 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) | T6 | Right foot, second digit | T7 | Right foot, third digit | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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. | T1 | Left foot, second digit | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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. | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | F1 | Left hand, second digit | F2 | Left hand, third digit | F3 | Left hand, fourth digit | F7 | Right hand, third digit | F8 | Right hand, fourth digit | GW | Service not related to the hospice patient's terminal condition | SG | Ambulatory surgical center (asc) facility service | T2 | Left foot, third digit | T3 | Left foot, fourth digit | T4 | Left foot, fifth digit | T5 | Right foot, great toe | T8 | Right foot, fourth digit | T9 | Right foot, fifth digit | TA | Left foot, great toe | TL | Early intervention/individualized family service plan (ifsp) | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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