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The procedure described by CPT® Code 28606 refers to the percutaneous skeletal fixation of a dislocated tarsometatarsal joint, which is a critical area in the foot where the metatarsal bones connect with the tarsal bones. This procedure involves a minimally invasive approach, utilizing a small skin incision to access the affected area. A corticotomy, which is a surgical procedure that involves creating a small opening in the bone, is performed using a specialized drill. This allows the surgeon to manipulate the dislocated bone back into its proper anatomical position. The reduction of the dislocation is achieved by carefully aligning the bones, ensuring that they are restored to their normal configuration. To secure the bones in place, one or more pre-bent Kirschner wires are inserted into the medullary canal of the metatarsal bone, extending across the tarsometatarsal joint and into the adjacent tarsal bone. This fixation method provides stability to the joint during the healing process. Additionally, the success of the reduction is confirmed through radiographic imaging, which is reported separately, ensuring that the anatomical alignment is accurately restored.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 28606 is indicated for the treatment of dislocations of the tarsometatarsal joint. This condition may arise due to various traumatic events, such as falls, sports injuries, or accidents, leading to the misalignment of the bones in the midfoot region. The primary symptoms prompting this procedure typically include significant pain, swelling, and an inability to bear weight on the affected foot. Additionally, the presence of visible deformity or instability in the tarsometatarsal joint may necessitate surgical intervention to restore proper function and alleviate discomfort.
The procedure begins with the surgeon making a small skin incision over the metatarsal bone, which provides access to the underlying structures. Following this, a specialized drill is utilized to create a corticotomy, allowing the surgeon to reach the dislocated tarsometatarsal joint. Once access is achieved, the dislocated bone is carefully manipulated back into its anatomical alignment. This reduction process is critical, as it restores the normal positioning of the bones, which is essential for proper function and healing. After achieving the correct alignment, one or more pre-bent Kirschner wires are advanced by hand into the medullary canal of the metatarsal bone. These wires are strategically placed to cross the tarsometatarsal joint and extend into the adjacent tarsal bone, providing necessary stabilization to the joint. The final step involves verifying the anatomical reduction of the dislocation through radiographic imaging, which is reported separately to confirm that the bones are properly aligned and secured.
After the completion of the procedure, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, immobilization of the foot to ensure proper healing, and instructions for weight-bearing activities. Patients are often advised to follow up with their healthcare provider for further evaluation and to assess the healing process. Rehabilitation may be necessary to restore full function and strength to the foot, and this may involve physical therapy to improve mobility and reduce stiffness. The expected recovery time can vary based on the severity of the dislocation and the individual patient's healing response.
| Short Descr | TREAT FOOT DISLOCATION | Medium Descr | PRQ SKEL FIXJ TARS JT DISLC W/MANJ | Long Descr | Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation | 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 | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 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). | 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 | 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 | 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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