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The CPT® Code 28666 refers to the procedure known as percutaneous skeletal fixation of an interphalangeal joint dislocation, which includes manipulation of the dislocated joint. This procedure is typically performed on the fingers or toes, where the interphalangeal joints are located. The term 'percutaneous' indicates that the procedure is done through the skin, minimizing the need for larger incisions. During the procedure, a small incision is made over the middle or distal phalanx, which are the bones of the fingers or toes. A specialized drill is then utilized to create a corticotomy, allowing access to the underlying bone structure. The dislocated phalangeal bones are carefully manipulated back into their proper anatomical position. To ensure that the joint remains stable and aligned during the healing process, one or more pre-bent Kirschner wires are inserted through the medullary canals of the phalangeal bones. This fixation method is crucial for maintaining the correct alignment of the joint. After the procedure, the successful reduction of the dislocation is confirmed through radiographs, which are separate imaging studies that can be reported independently. This procedure is essential for restoring function and stability to the affected joint, thereby facilitating recovery and rehabilitation.
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The procedure described by CPT® Code 28666 is indicated for the treatment of dislocations of the interphalangeal joints. These dislocations may occur due to trauma, such as sports injuries, falls, or accidents, leading to misalignment of the phalangeal bones. The primary symptoms prompting this procedure include visible deformity of the finger or toe, pain, swelling, and loss of function in the affected joint. The procedure aims to restore normal anatomical alignment and function, alleviating pain and preventing long-term complications associated with untreated dislocations.
The procedure begins with the patient positioned appropriately to allow access to the affected digit. A small skin incision is made over the middle or distal phalanx, which is the area where the dislocated joint is located. This incision is minimal, aimed at reducing tissue trauma. Following the incision, a small drill is utilized to create a corticotomy, which involves drilling into the bone to facilitate access to the medullary canal. Once the corticotomy is performed, the dislocated phalangeal bones are carefully manipulated back into their anatomical alignment. This step is critical, as proper alignment is necessary for the joint to function correctly post-procedure. To maintain this alignment, one or more pre-bent Kirschner wires are then advanced by hand through the medullary canals of the phalangeal bones. These wires serve as internal fixation devices, stabilizing the joint during the healing process. After the fixation is complete, the surgeon verifies the successful reduction of the dislocation through radiographs, which are separate imaging studies that confirm the correct positioning of the bones.
After the procedure, the patient will typically be monitored for any immediate complications. Post-procedure care may include immobilization of the affected digit to ensure proper healing and alignment. The use of a splint or cast may be recommended to protect the joint during the recovery period. Patients are usually advised to follow up with their healthcare provider for assessment of healing and to monitor for any signs of complications, such as infection or improper healing. Rehabilitation exercises may be introduced gradually to restore range of motion and strength in the joint once healing has progressed adequately. The expected recovery time can vary based on the severity of the dislocation and the individual patient's healing response.
| Short Descr | TREAT TOE DISLOCATION | Medium Descr | PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ | Long Descr | Percutaneous skeletal fixation of interphalangeal 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). | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 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.) | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F4 | Left hand, fifth digit | 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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