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The procedure described by CPT® Code 28150 refers to a phalangectomy of the toe, which involves the surgical removal of a phalanx, or bone segment, from each toe. This intervention is primarily indicated for patients experiencing severe malalignment of the metatarsophalangeal joint, which can lead to conditions such as underlapping, overlapping, or cock-up deformities of the toe. The term 'phalangectomy' specifically denotes the excision of bone rather than soft tissue, distinguishing it from an amputation. During the procedure, a dorsal Z-type incision is utilized to address underlapping toes, while a volar elliptical incision is employed for overlapping or cock-up toes. The surgical approach typically involves the excision of the proximal phalanx, which is the bone closest to the foot. Additionally, the procedure entails incising the joint capsules of both the metatarsophalangeal and proximal interphalangeal joints, followed by the removal of the phalanx. As part of the surgical technique, the flexor and extensor tendons may be released as necessary to facilitate proper alignment and function. To ensure stability and alignment of the remaining bones, an intramedullary K-wire may be inserted into the middle and distal phalanges as well as into the metatarsal bone. This procedure is reported using the CPT® Code 28150 for each toe that undergoes the phalangectomy.
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The phalangectomy procedure, as described by CPT® Code 28150, is indicated for specific conditions related to severe malalignment of the toe. The following are the primary indications for performing this procedure:
The phalangectomy procedure involves several critical steps to ensure the successful removal of the phalanx and correction of the toe's alignment. The following outlines the procedural steps:
After the phalangectomy procedure, patients can expect specific post-operative care and recovery considerations. It is essential to monitor the surgical site for signs of infection and to manage pain effectively. Patients may be advised to keep the foot elevated to reduce swelling and to follow specific instructions regarding weight-bearing activities. The K-wire, if used, may require removal after a designated period, depending on the surgeon's assessment of healing and alignment. Follow-up appointments will be necessary to evaluate the recovery process and ensure that the toe is healing correctly and functioning as intended.
| Short Descr | REMOVAL OF TOE | Medium Descr | PHALANGECTOMY TOE EACH TOE | Long Descr | Phalangectomy, toe, each toe | 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) | P6B - Minor 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). | 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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) | 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 | 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 | 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 | 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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