Arthrodesis
Coding Atlas
In arthrodesis, the joint is surgically fused and
immobilized. Bone grafts may be placed to fix the joint;
otherwise, hardware is placed. Code selection is based on the joint(s) treated.
27870 Arthrodesis, ankle, open
27871 Arthrodesis, tibiofibular joint, proximal or distal
Amputation
Coding Atlas
A guillotine amputation creates a flat wound across the limb. It does not provide skin for adequate closure.
Guillotine amputation is typically performed in emergent situations and is followed by wound monitoring for disease prior to a second surgery for revision and flap.
27880 Amputation, leg, through tibia and fibula;
27881 with immediate fitting technique including application of first cast
27882 open, circular (guillotine) 27884 secondary closure or scar revision 27886 re-amputation
27888 Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nerves
27889 Ankle disarticulation
Other Procedures
Coding Atlas
If compartment syndrome (CS) is not treated, blood flow to muscle tissue is compromised and necrosis results.
These codes are used to report decompression fasciotomy with debridement of necrotic or otherwise nonviable tissues within the compartment.
27892 Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve
27893 posterior compartment(s) only, with debridement of nonviable muscle and/or nerve
27894 anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerve
Superficial fibular (peroneal) nerve (cut) Fibularis (peroneus) brevis muscle Fibularis (peroneus) longus tendon
Extensor digitorum longus muscle and tendon Superior extensor retinaculum
Fibula Perforating branch of fibular (peroneal) artery Lateral malleolus and anterior lateral malleolar artery Inferior extensor retinaculum Lateral tarsal artery and lateral branch of deep peroneal nerve (to muscles of dorsum of foot) Fibularis (peroneus) brevis tendon
Fibularis (peroneus) tertius tendon Tuberosity of 5th metatarsal bone
Extensor digitorum brevis and extensor hallucis brevis muscles
Extensor digitorum longus tendons Lateral dorsal cutaneous nerve (continuation of sural nerve) (cut) Dorsal metatarsal arteries
Dorsal digital arteries Dorsal branches of proper plantar digital arteries and nerves
Tibialis anterior tendon Anterior tibial artery and deep fibular (peroneal) nerve
Tibia
Extensor hallucis longus tendon Tendinous sheath of
extensor digitorum longus Medial malleolus
Tendinous sheath of tibialis anterior Tendinous sheath of extensor hallucis longus Anterior medial malleolar artery Dorsalis pedis artery and medial branch of deep fibular (peroneal) nerve
Medial tarsal artery Arcuate artery
Deep plantar artery passing between heads of 1st dorsal interosseous muscle to join deep plantar arch
Extensor hallucis longus tendon Extensor expansions
Dorsal digital branches of deep fibular (peroneal) nerve
Dorsal digital branches of superficial fibular (peroneal) nerve FIGURE 2-49. Soft Tissue of the Foot
In addition to 26 bones, the foot has more than 100 muscles, tendons, and ligaments. The extensor muscles and tendons help to raise and extend the toes, an essential part of precision locomotion. The flexor muscles and tendons bend the toes in flexion.
110 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding28043 Excision, tumor, soft tissue of foot or toe, subcutaneous;
less than 1.5 cm # 28039 1.5 cm or greater
28045 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm
# 28041 1.5 cm or greater
28046 Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm
28047 3 cm or greater
28050 Arthrotomy with biopsy; intertarsal or tarsometatarsal joint
28052 metatarsophalangeal joint 28054 interphalangeal joint
28055 Neurectomy, intrinsic musculature of foot
28060 Fasciectomy, plantar fascia; partial (separate procedure) 28062 radical (separate procedure)
28070 Synovectomy; intertarsal or tarsometatarsal joint, each 28072 metatarsophalangeal joint, each
28080 Excision, interdigital (Morton) neuroma, single, each 28086 Synovectomy, tendon sheath, foot; flexor
28088 extensor
28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot 28092 toe(s), each
28100 Excision or curettage of bone cyst or benign tumor, talus or calcaneus;
28102 with iliac or other autograft (includes obtaining graft) 28103 with allograft
28104 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;
28106 with iliac or other autograft (includes obtaining graft) 28107 with allograft
28108 Excision or curettage of bone cyst or benign tumor, phalanges of foot
28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
28111 Ostectomy, complete excision; first metatarsal head 28112 other metatarsal head (second, third or fourth) 28113 fifth metatarsal head
28114 all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure)
28116 Ostectomy, excision of tarsal coalition 28118 Ostectomy, calcaneus;
28119 for spur, with or without plantar fascial release 28120 Partial excision (craterization, saucerization,
sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus
28122 tarsal or metatarsal bone, except talus or calcaneus 28124 phalanx of toe
28126 Resection, partial or complete, phalangeal base, each toe
28130 Talectomy (astragalectomy) 28140 Metatarsectomy
28150 Phalangectomy, toe, each toe
28153 Resection, condyle(s), distal end of phalanx, each toe 28160 Hemiphalangectomy or interphalangeal joint excision,
toe, proximal end of phalanx, each
28171 Radical resection of tumor; tarsal (except talus or calcaneus)
28173 metatarsal 28175 phalanx of toe
Introduction or Removal
Coding Atlas
Codes 28190-28193 are used to report removal of a foreign body that is the result of recent or past trauma.
These codes should not be used to report removal of prosthesis.
28190 Removal of foreign body, foot; subcutaneous
28192 deep
28193 complicated
Repair, Revision, and/or Reconstruction
Coding Atlas
A hallux valgus is a bunion, or forefoot deformity, in which there is a lateral deviation in the great toe. This deformity is usually acquired (extrinsic factor, such as the types of shoes worn) and more frequently seen in women as a result of genetic predisposition (intrinsic factor). The goal of surgery for hallux valgus is correction of the defect, which may be accomplished by osteotomy, resection arthroplasty, or arthrodesis.
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
28043—28193Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 111
28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon
28202 secondary with free graft, each tendon (includes obtaining graft)
28208 Repair, tendon, extensor, foot; primary or secondary, each tendon
28210 secondary with free graft, each tendon (includes obtaining graft)
28220 Tenolysis, flexor, foot; single tendon 28222 multiple tendons
28225 Tenolysis, extensor, foot; single tendon 28226 multiple tendons
28230 Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)
28232 toe, single tendon (separate procedure) 28234 Tenotomy, open, extensor, foot or toe, each tendon 28238 Reconstruction (advancement), posterior tibial tendon
with excision of accessory tarsal navicular bone (eg, Kidner type procedure)
28240 Tenotomy, lengthening, or release, abductor hallucis muscle
28250 Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)
28260 Capsulotomy, midfoot; medial release only (separate procedure)
28261 with tendon lengthening
28262 extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)
28264 Capsulotomy, midtarsal (eg, Heyman type procedure) 28270 Capsulotomy; metatarsophalangeal joint, with or without
tenorrhaphy, each joint (separate procedure)
28272 interphalangeal joint, each joint (separate procedure) 28280 Syndactylization, toes (eg, webbing or Kelikian type
procedure)
28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
28286 Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure)
28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint
28290 Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure)
28292 Keller, McBride, or Mayo type procedure 28293 resection of joint with implant
28294 with tendon transplants (eg, Joplin type procedure) 28296 with metatarsal osteotomy (eg, Mitchell, Chevron, or
concentric type procedures) 28297 Lapidus-type procedure 28298 by phalanx osteotomy 28299 by double osteotomy
28300 Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation
28302 talus
28304 Osteotomy, tarsal bones, other than calcaneus or talus;
28305 with autograft (includes obtaining graft) (eg, Fowler type)
28306 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal 28307 first metatarsal with autograft (other than first toe) 28308 other than first metatarsal, each
28309 multiple (eg, Swanson type cavus foot procedure) 28310 Osteotomy, shortening, angular or rotational correction;
proximal phalanx, first toe (separate procedure) 28312 other phalanges, any toe
28313 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)
28315 Sesamoidectomy, first toe (separate procedure) 28320 Repair, nonunion or malunion; tarsal bones 28322 metatarsal, with or without bone graft (includes
obtaining graft)
28340 Reconstruction, toe, macrodactyly; soft tissue resection 28341 requiring bone resection
28344 Reconstruction, toe(s); polydactyly
28345 syndactyly, with or without skin graft(s), each web 28360 Reconstruction, cleft foot
28200—28360
Musculoskeletal System
Netter’s Atlas of Surgical Anatomy for CPT Coding112 Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code
Base of proximal phalanx and exostosis resected.
Medullary canal prepared and single-stemmed implant inserted. Capsular flap sutured to proximal phalanx.
Capsule reflected from proximal phalanx interposed into joint and sutured over raw area of metatarsal head (pin fixation may be used if necessary)
About half of proximal phalanx and exostosis resected (shown in blue) and toe straightened Callosity
Callosity Corn
Portion of joint resected (blue-shaded areas)
Portion of proximal interphalangeal joint resected (blue-shaded areas)
In very mild cases, transcutaneous extensor tenotomy without bone resection followed by manipulative alignment may suffice.
Toe aligned with or without Kirschner wire.
Extensor tenotomy over metatarsophalangeal joint. Callosity and corn heal.
Toe straightened; joint fused and fixed with screw. Callosity heals.
Keller operation for hallux valgus with bunion (other toes satisfactory)
Swanson flexible implant resection arthroplasty for great toe Hyperextension deformity of great toe
Cock-up deformity of lesser toe (metatarsophalangeal joint satisfactory) FIGURE 2-50. Correction of Toe Deformities
Toe-joint deformities are commonly corrected with surgery that may involve the bone, tendons, or ligaments, or a combination of those structures. In hallux valgus, the joint at the base of the big toe is deformed, causing a painful outward (lateral) bowing. The first metatarsal becomes prominent in the medial foot, creating what is commonly called a bunion. Note: Tools, implants, and/or equipment depicted in the illustration may be outdated but the procedural approach is valid.
Moderate sedation ✚Add-on code Modifier 51 exempt #Resequenced code © 2015 American Medical Association 113
Netter’s Atlas of Surgical Anatomy for CPT Coding
Musculoskeletal System
Dorsal view
Calcaneus BodyFibular (peroneal) trochlea Tarsal sinus Transverse tarsal joint Cuboid
Metatarsal bones
Phalanges Proximal Middle Distal
Lateral tubercle Medial tubercle
Trochlea Neck Head
Navicular Tuberosity Lateral Intermediate Medial
Tarsometatarsal joint Base
Shaft (body)
Head Base Shaft (body) Head Base
Tuberosity
Plantar view
Talus
Calcaneus Tuberosity
Medial process Lateral process
Sustentaculum tali
Fibular (peroneal) trochlea
Tuberosity
l
Tuberosity of 5th metatarsal bone
Base Shaft (body) Head Base Shaft (body) Head Base Head Base Tuberosity Cuneiform bones
Transverse tarsal joint Navicular
Tuberosity Lateral Intermediate Medial Tarsometatarsal joint
Metatarsal bones Sesamoid bones Medial
Lateral
Phalanges
Proximal Middle Distal
Lateral tubercle Medial tubercle Posterior process Head
Talus 5
1 Cuneiform bones
2 3 4 5
4 3 2 1
Posterior process
Cuboid
Tuberosity of 5th metatarsal bone
Groove for tendon of flexor hallucis longus
Groove for fibularis (peroneus) longus tendon Groove for
tendon of flexor hallucis longus
Talus
Transverse tarsal joint Navicular Head
Neck Trochlea Lateral process Posterior process
Intermediate
Lateral Cuneiform bones Tarsometatarsal joint
Metatarsal bones
Phalanges Tarsal sinus
Calcaneus Body
Tuberosity Fibular (peroneal) trochlea
Cuboid Tuberosity
Medial view Transverse tarsal joint
Navicular Tuberosity Cuneiform bones Intermediate
Tarsometatarsal joint Metatarsal bones Phalanges
Talus Neck
Head Trochlea
Sesamoid bone
Posterior process
Tuberosity
Sustentaculum tali
Calcaneus 5
Medial 4
3 2
2 1 Groove for
fibularis (peroneus) longus tendon
Groove for fibularis (peroneus) longus tendon
Tuberosity of 5th metatarsal bone
Tuberosity of
1st metatarsal bone Groove for tendon of
flexor hallucis longus Lateral view
FIGURE 2-51. Bones of the Foot
The foot contains 26 bones (plus two tiny sesamoid bones): 7 tarsal, 5 metatarsal, and 14 phalanges.
The foot is divided into hindfoot, midfoot, and forefoot. The hindfoot contains two tarsal bones (calcaneus and talus). The midfoot contains the balance of the tarsal bones (three cuneiform, one navicular, and one cuboid). The forefoot contains the metatarsals and phalanges. The sesamoid bones are embedded in the muscles of the forefoot connected to the tendons.
Fracture and/or Dislocation
Coding Atlas