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The procedure described by CPT® Code 28760 refers to an arthrodesis involving the great toe, specifically the interphalangeal joint. Arthrodesis is a surgical procedure that fuses two bones together, in this case, the proximal and distal phalanx of the great toe, to eliminate movement at the joint. This is often indicated in cases where there is severe joint pain or instability, typically due to conditions such as arthritis or injury. The procedure involves a meticulous surgical approach, beginning with an incision made over the lateral aspect of the interphalangeal joint. Surgeons must take care to protect surrounding nerves and blood vessels during this process. Once the joint is accessed, the articular cartilage is excised, which is the smooth tissue that covers the ends of bones in a joint, allowing for smooth movement. The next step involves scaling the articular surfaces of the proximal and distal phalanx using an osteotome, a specialized surgical instrument. This prepares the bone surfaces for fusion by exposing cancellous bone, which is the spongy bone that facilitates healing and integration. A key component of this procedure is the transfer of the extensor hallucis longus tendon to the first metatarsal neck. This tendon is responsible for extending the big toe and its transfer helps to stabilize the joint post-fusion. To ensure stability during the healing process, internal fixation devices such as pins, screws, staples, or a small plate are utilized to hold the bones in place across the joint. Finally, the incision is closed, and a bulky dressing is applied to protect the surgical site and support the healing process. This comprehensive approach aims to alleviate pain and restore function to the great toe, enhancing the patient's overall mobility and quality of life.
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The procedure described by CPT® Code 28760 is indicated for specific conditions affecting the great toe, particularly the interphalangeal joint. The following are the explicitly provided indications for performing this procedure:
The procedure for CPT® Code 28760 involves several critical steps to ensure successful arthrodesis of the great toe. Each step is detailed as follows:
Post-procedure care following an arthrodesis of the great toe is essential for optimal recovery. Patients can expect to have a bulky dressing applied to the surgical site, which should remain intact until the first follow-up appointment. It is important to monitor the incision for any signs of infection or complications. Patients may be advised to limit weight-bearing activities on the affected foot for a specified period to allow for proper healing. Rehabilitation may include physical therapy to restore mobility and strength in the toe and foot once the initial healing phase has passed. Follow-up visits will be necessary to assess the healing process and determine when it is safe to resume normal activities.
| Short Descr | FUSION OF BIG TOE JOINT | Medium Descr | ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK | Long Descr | Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
This is a primary code that can be used with these additional add-on codes.
| 20705 | Add-on Code MPFS Status: Active Code APC N Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) |
| 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.) | 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 | FA | Left hand, thumb | 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) | SA | Nurse practitioner rendering service in collaboration with a physician | SG | Ambulatory surgical center (asc) facility service | T2 | Left foot, third digit | T3 | Left foot, fourth digit | T5 | Right foot, great toe | T6 | Right foot, second 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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