Summary & Overview
CPT 28112: Metatarsal Head Resection for Necrosis or Infection
CPT code 28112 denotes a surgical resection of the second, third, or fourth metatarsal head performed for necrosis or infection. This procedure is clinically significant because it addresses focal bone loss and active infection in the forefoot, conditions that can cause severe pain, limit ambulation, and risk broader soft-tissue or systemic spread. Nationally, procedures addressing metatarsal head osteonecrosis or osteomyelitis are important for surgical, orthopedic, and podiatric practices and for payers managing post-acute outcomes and infection-related costs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and typical settings of care, summary benchmarks where available, common coding and billing considerations, and policy and coverage contexts that influence utilization and authorization. The publication outlines relevant clinical context for coding accuracy, highlights common modifier usage patterns (list provided separately), and signals where readers should look for documentation and coverage criteria.
This national-level discussion is intended to help billing managers, clinicians, and policy analysts understand the purpose of CPT code 28112, typical sites of service, and the payer landscape affecting reimbursement and utilization oversight.
Billing Code Overview
CPT code 28112 describes a surgical procedure in which the provider removes the bone of the second, third, or fourth metatarsal head due to necrosis or infection of the metatarsal head. This procedure is a partial metatarsal head resection aimed at removing diseased bone tissue to control infection and relieve pain.
Service Type: Surgical — Forefoot bone resection
Typical Site of Service: Hospital operating room or ambulatory surgery center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with poorly controlled diabetes presents with persistent forefoot pain, swelling, and draining sinus adjacent to the second metatarsal head. Imaging (plain radiographs and MRI) demonstrates osteonecrosis and cortical destruction of the second metatarsal head with adjacent soft-tissue abscess. The patient has failed conservative therapy including antibiotics and offloading for several weeks and is scheduled for operative management.
The clinical workflow begins with preoperative evaluation by the foot and ankle surgeon including review of imaging, optimization of glycemic control, and perioperative antibiotic planning. On the day of service, the patient undergoes regional or general anesthesia in an ambulatory surgical center or hospital operating room. The surgeon performs a dorsal or plantar incision, performs debridement of infected soft tissue, and surgically removes the necrotic metatarsal head (second, third, or fourth as appropriate). Intraoperative cultures and bone biopsy are commonly obtained. Postoperative care includes wound management, partial-weight-bearing or immobilization, and directed antibiotic therapy based on culture results. Follow-up includes wound checks, monitoring for recurrent infection, and assessment of forefoot biomechanics with possible need for orthotics or further reconstructive procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT / RT |