Summary & Overview
CPT 28114: Resection of 2nd–5th Metatarsal Heads and Proximal Phalanges
CPT code 28114 denotes a surgical procedure that completely removes the second through fifth metatarsal heads and their corresponding proximal phalanges, typically to manage osteonecrosis or severe infection of the forefoot. This code represents a specialized forefoot resection performed in an operating room or ambulatory surgery center and is relevant for hospitals, surgical centers, and orthopaedic and podiatric practices. Nationally, accurate coding for this procedure affects clinical reporting, episode-of-care classification, and payment for complex reconstructive or salvage foot surgery.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the code’s clinical context, typical sites of service, common billing modifiers (listed separately), and where the service fits within surgical and wound-care pathways. The publication outlines benchmarks for utilization and payment patterns where available, summarizes recent policy updates affecting surgical foot procedures, and provides guidance on clinical documentation elements that support coding for extensive metatarsal and phalangeal resections. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 28114 describes the surgical removal of the bones of the second through fifth metatarsal heads along with their corresponding proximal phalanges to treat necrosis or infection. This procedure removes multiple metatarsal head segments and adjacent proximal phalanges.
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Service type: Surgical debridement and partial foot resection
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Typical site of service: Operating room or ambulatory surgery center for foot surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is an older adult with chronic osteomyelitis or avascular necrosis of the lesser metatarsal heads (second–fifth) who presents with persistent forefoot pain, drainage, recurrent infection, or nonhealing ulcers despite conservative care. The patient often has comorbidities such as peripheral vascular disease or diabetes mellitus that impair healing. Preoperative workflow includes clinical history, focused foot exam, plain radiographs and/or MRI to define extent of bone destruction, vascular assessment as indicated, optimization of glycemic control, and informed consent discussing risks including wound healing problems and transfer lesions.
In the operating room under regional or general anesthesia, the surgeon performs surgical excision of the metatarsal heads (second through fifth) and corresponding proximal phalanges as a single-session resection to remove necrotic or infected bone. Intraoperative cultures and margin assessment may be obtained. Postoperative care includes dressing changes, possible negative-pressure wound therapy, targeted antibiotics based on cultures, offloading and graduated weight-bearing, and outpatient wound checks with podiatry or orthopedic surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left foot |