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The procedure described by CPT® Code 28286 involves the correction of a cock-up fifth toe, which is a condition where the fifth toe is positioned in a dorsiflexed manner at the proximal interphalangeal (PIP) joint. This correction is achieved through a surgical technique known as the Ruiz-Mora procedure, which utilizes a plastic skin closure to ensure proper healing and alignment of the toe. The surgical approach begins with a dorsal incision made over the PIP joint of the fifth toe, allowing access to the underlying structures. During the procedure, an ellipse of skin is excised from below the proximal phalanx, slightly medial to the incision margin, to facilitate the correction. The flexor tendons are carefully dissected and retracted to expose the PIP joint, where the joint capsule is incised, and the collateral ligaments are released to allow for proper alignment. The head of the proximal phalanx may be excised, or in some cases, the entire proximal phalanx may be removed. If significant portions of the proximal phalanx are excised, the flexor and extensor tendons are secured together using purse-string sutures. Finally, a plastic repair of the skin is performed to maintain the toe in the correct plantar-medial direction, ensuring both functional and aesthetic outcomes for the patient.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure is indicated for the correction of a cock-up fifth toe, which may present as a deformity characterized by the fifth toe being flexed upwards at the proximal interphalangeal (PIP) joint. This condition can lead to discomfort, difficulty in footwear fitting, and potential complications such as calluses or ulcers due to abnormal pressure points. The surgical intervention aims to restore proper alignment and function of the toe.
The procedure involves several key steps to effectively correct the cock-up fifth toe. First, a dorsal incision is made over the proximal interphalangeal (PIP) joint of the fifth toe. This incision provides access to the underlying anatomical structures. Following the incision, an ellipse of skin is excised from below the proximal phalanx, slightly medial to the margin of the incision. This excision is crucial for facilitating the correction of the toe's position. Next, the flexor tendons are carefully dissected and retracted to expose the PIP joint adequately. Once the joint is accessible, the joint capsule is incised, allowing for the release of the collateral ligaments, which is essential for restoring normal joint function. The head of the proximal phalanx is then excised; alternatively, the entire proximal phalanx may be removed depending on the severity of the deformity. In cases where a significant portion of the proximal phalanx is excised, the flexor and extensor tendons are joined together using purse-string sutures to maintain stability. Finally, a plastic repair of the skin is performed to ensure that the toe is maintained in the correct plantar-medial direction, promoting optimal healing and alignment.
Post-procedure care involves monitoring the surgical site for signs of infection and ensuring proper healing of the incision. Patients may be advised to keep the foot elevated to reduce swelling and to follow specific instructions regarding weight-bearing activities. Pain management may be necessary, and follow-up appointments will be scheduled to assess the healing process and the alignment of the toe. Rehabilitation exercises may also be recommended to restore mobility and strength in the toe and foot.
| Short Descr | REPAIR OF HAMMERTOE | Medium Descr | CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE | Long Descr | Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure) | 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) | 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 | 1 | CCS Clinical Classification | 143 - Bunionectomy or repair of toe deformities |
| 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). | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | F8 | Right hand, fourth digit | 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) | T1 | Left foot, second 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| Pre-1990 | Added | Code added. |
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