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08/11/2003    Edward Orman, DPM

Coding for MTPJ Repair

Query: Coding for MTPJ Repair


A 49 year old male fractured his right 2nd toe
in March. He was initially treated by his
primary care physician, who taped the 1st
and 2nd toes together. He came to me in June
with continued pain on plantar-lateral aspect of
the 2nd MTPJ. The 2nd toe was starting to
adduct, but had not yet overlapped the hallux. X-
rays shows a non-union with a 5mm bone fragment
at the lateral base of the proximal
phalanx. The bone fragment involved the joint.
Because the toe is adducting, there may also be
ruptured lateral collateral ligament to
the 2nd MTPJ. I plan to remove the bone and
repair the ligament, if ruptured.


What would be the correct code? I can only find
a code for repair of ankle ligament. Would I use
open reduction for dislocated MTPJ?


Edward Orman, DPM
Baltimore, MD


Codingline Reponses:


You are correct that there is no specific code
for this procedure. Your options, however, would
be to bill for CPT 28270 (capsulotomy;
metatarssal-phalangeal joint, with or without
tenorrhaphy, each joint). Or the excision of the
bone fragment, CPT 28124. You should not bill
both codes. Select the procedure code that most
closely reflects the actual work you primarily
performed.


Tony Poggio, DPM
Alameda, CA


I am going out on a limb here, but CPT 28270 and
CPT 28124 are not linked in the Correct Coding
Intiative (CCI). I see no reason that both codes
could 'not' be billed at the same time if both
procedures were performed. The CCI links all
codes they feel should be bundled. It leans
towards linking everything so there must be a
reason they did not link these two.


Ken Malkin DPM
Caldwell, NJ


I usually use CPT 28270 (capsulotomy; metatarsal-
phalangeal joint, with or without tenorrhaphy,
each joint). Alternatively, you could code for
the removal of the base of the proximal phalanx -
CPT 28126. I don't think billing both codes
would be tolerated.


Walter J Pedowitz MD
Linden, NJ


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