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The CPT® Code 28636 refers to the procedure known as percutaneous skeletal fixation of a metatarsophalangeal joint dislocation, which includes manipulation of the dislocated joint. This procedure is performed to address dislocations that occur at the metatarsophalangeal joint, which is the joint located at the base of the toes where the metatarsal bones meet the proximal phalanges. The term 'percutaneous' indicates that the procedure is performed through the skin with minimal incisions, allowing for less trauma to the surrounding tissues compared to open surgical techniques. During the procedure, a small incision is made over the affected metatarsal or phalangeal bone, and a drill is utilized to create a corticotomy, which is a surgical opening in the cortex of the bone. This allows for access to the dislocated bones, which are then carefully manipulated back into their proper anatomical position. To ensure that the joint remains stable and in alignment during the healing process, one or more pre-bent Kirschner wires are inserted through the medullary canals of the metatarsal and phalangeal bones. The successful reduction of the dislocation is confirmed through radiographic imaging, which is reported separately. This procedure is essential for restoring function and alleviating pain associated with metatarsophalangeal joint dislocations.
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The procedure described by CPT® Code 28636 is indicated for the treatment of dislocations of the metatarsophalangeal joint. This condition may arise due to various factors, including trauma, sports injuries, or falls, leading to significant pain, swelling, and functional impairment of the affected toe. The procedure is performed to restore the normal anatomical alignment of the joint, alleviate pain, and improve mobility.
The procedure begins with the patient being positioned appropriately to allow access to the affected foot. A small skin incision is made over the metatarsal or phalangeal bone, which is the area where the dislocation has occurred. This incision is designed to minimize tissue damage while providing sufficient access for the surgical instruments. Following the incision, a small drill is utilized to create a corticotomy, which involves drilling into the cortex of the bone to facilitate access to the dislocated joint. Once the corticotomy is performed, the surgeon carefully manipulates the dislocated bones back into their correct anatomical alignment. This step is crucial as it restores the normal function of the joint. To maintain the joint in this proper alignment, one or more pre-bent Kirschner wires are then advanced by hand through the medullary canals of both the metatarsal and phalangeal bones. These wires serve as internal fixation devices, stabilizing the joint during the healing process. After the fixation is completed, the surgeon verifies the successful reduction of the dislocation through radiographs, which are separately reportable. This imaging confirms that the bones are properly aligned and that the procedure has been successful.
After the completion of the procedure, the patient will typically be monitored for any immediate complications. Post-procedure care may include instructions for pain management, which can involve the use of analgesics as prescribed. The affected foot may need to be immobilized to ensure proper healing, and the patient may be advised to avoid weight-bearing activities for a specified period. Follow-up appointments will be necessary to assess the healing process and to remove any fixation devices, such as the Kirschner wires, once adequate healing has occurred. Radiographic evaluations may also be performed during follow-up visits to ensure that the joint remains in proper alignment and to monitor the recovery progress.
| Short Descr | TREAT TOE DISLOCATION | Medium Descr | PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ | Long Descr | Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulation | Status Code | Active Code | Global Days | 010 - Minor Procedure | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 4 | 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.) | 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) | 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 |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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