Summary & Overview
CPT 28113: Excision of Fifth Metatarsal Head for Necrosis or Infection
CPT code 28113 denotes surgical removal of the bone of the fifth metatarsal head for cases of necrosis or infection. This procedure is clinically significant because it addresses destructive disease processes in the lateral forefoot that can cause pain, functional impairment, and risk of systemic infection. Nationally, this code maps to inpatient and outpatient operative settings and is relevant to orthopedics, podiatry, and surgical care management.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise clinical context for use of the code, typical sites of service, and common billing modifiers associated with operative musculoskeletal codes. The publication also outlines benchmarking and policy-relevant considerations that affect authorization, site-of-service determination, and coding accuracy for foot procedures.
The piece provides a practical reference for coders, billing managers, and clinical operations leaders seeking to align documentation with procedural definitions, anticipate payer interactions, and understand where CPT code 28113 fits within surgical foot care coding and reimbursement workflows.
Billing Code Overview
CPT code 28113 describes a surgical procedure in which the provider removes the bone of the fifth metatarsal head due to necrosis or infection of the metatarsal head. This is an operative musculoskeletal procedure focused on excision of diseased bone in the foot.
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Service type: Surgical excision of bone (operative procedure)
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Typical site of service: Ambulatory surgery center or hospital operating room, depending on clinical severity and patient needs.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with diabetes and peripheral vascular disease presents with persistent pain, erythema, and drainage over the lateral forefoot. Imaging demonstrates osteomyelitis and necrosis isolated to the head of the fifth metatarsal. Nonoperative measures including antibiotics and local wound care have failed. The orthopedic foot and ankle surgeon schedules a surgical excision of the necrotic fifth metatarsal head under regional block with intraoperative cultures obtained.
Preoperative workflow includes history and physical, review of vascular status and glycemic control, pre-op labs, and informed consent documenting the indication of necrosis/infection. Intraoperatively, the surgeon performs exposure of the fifth metatarsal head, debridement of necrotic bone, excision of the metatarsal head, obtains bone cultures, and irrigates the wound. Hemostasis is achieved, and closure or delayed primary closure is performed depending on infection severity. Postoperative care includes targeted intravenous or oral antibiotics guided by culture, wound checks, limited weight-bearing with a postoperative shoe or cast, and follow-up with wound care and infectious disease as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When the same procedure is performed on both feet during the same operative session |