Summary & Overview
CPT 28150: Excision of One Toe Phalanx
CPT code 28150 denotes surgical excision of one toe phalanx to treat disease or deformity, including complete removal when partial excision is insufficient. Nationally, this code captures a focused podiatric/orthopedic operative service that affects outpatient surgical billing, payer coverage determinations, and coding accuracy for toe salvage or resection procedures. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for use of the code, typical sites of service, common billing modifiers reported with operative procedures of this type, and guidance on documentation elements that support medical necessity. The publication provides benchmarks and coding practices relevant to ambulatory surgery centers and hospital outpatient departments and summarizes common policy considerations payers apply to toe phalanx excision, such as coverage criteria for disease severity and prior authorization requirements where applicable. Data not provided in the input includes specific reimbursement rates, payer-specific coverage policies, and associated ICD-10 diagnosis mappings. This summary serves clinicians, coding professionals, and policy analysts seeking a concise national overview of the code's clinical intent and billing implications.
Billing Code Overview
CPT code 28150 describes the surgical removal of a single toe phalanx when disease or deformity of the toe requires excision. The procedure involves complete removal of the phalanx when partial excision cannot adequately treat major disease of the bone.
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Service type: Surgical excision of bone (partial or complete phalanx removal)
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Typical site of service: Outpatient surgical suite or hospital operating room, depending on clinical complexity and patient needs.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with a painful, deformed, or infected toe due to osteomyelitis, progressive arthritis, trauma with comminution of the phalanx, or a severe hammertoe deformity refractory to conservative care. The patient often has failed nonoperative management such as antibiotics, splinting, footwear modification, or partial phalangeal resection. Preoperative workup includes history and physical, weight-bearing or targeted foot radiographs, possible MRI if occult osteomyelitis is suspected, and optimization of comorbid conditions (for example, diabetes mellitus). Informed consent documents the indication for complete removal of the diseased phalanx when partial excision is insufficient.
On the day of service the procedure is performed in an ambulatory surgical center or hospital operating room under regional or general anesthesia or monitored anesthesia care. The surgeon prepares the toe with sterile technique, makes appropriate dorsal or lateral incisions, removes the affected phalanx completely, achieves hemostasis, performs any necessary soft tissue repair, and applies dressings and a postoperative shoe or cast. Postoperative care includes pain control, wound checks, activity restrictions, and, if needed, antibiotic therapy and follow-up imaging. The typical site of service is an operating room in an ambulatory surgical center or hospital inpatient/outpatient surgical unit depending on patient comorbidities and complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |