Summary & Overview
CPT 28153: Toe Amputation, Distal Phalanx Condyle Removal
CPT code 28153 denotes a surgical amputation procedure in which the condyle at the distal end of a phalanx is removed, effectively amputating the toe. Nationally, this code is used for definitive surgical management of conditions that necessitate partial toe amputation, including severe infection, trauma, ischemia, or neoplasm when conservative measures are inadequate. Accurate coding affects coverage determinations, facility billing, and quality measurement for limb-preserving care.
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 context and typical sites of service, plus benchmarks and payer coverage perspectives where available. The publication outlines common billing considerations, customary utilization settings (operating room, ambulatory surgical center, hospital inpatient), and how this procedure is classified for procedural reporting.
This summary provides the clinical meaning of the code, the national relevance for surgical and billing workflows, and what to expect in the full publication: comparative benchmarks, recent policy updates that affect coverage or prior authorization practices, and operational implications for surgical services and revenue cycle teams.
Billing Code Overview
CPT code 28153 describes the surgical removal of the condyle at the distal end of a phalanx, resulting in amputation of the toe. This procedure is a surgical amputation of a toe segment and is performed by a qualified surgeon.
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Service type: Surgical procedure — toe amputation (distal phalanx condyle removal)
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Typical site of service: Operating room, ambulatory surgical center, or hospital inpatient/same-day surgery setting depending on clinical context and patient condition.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 68-year-old with chronic nonhealing diabetic foot ulceration and osteomyelitis localized to the distal phalanx of the second toe with intractable pain and recurrent infection despite conservative therapy. The patient presents to an outpatient podiatric or orthopedic clinic for preoperative evaluation. Workup includes focused foot exam, radiographs confirming distal phalangeal destruction, optimization of glycemic control, assessment of vascular status, and informed consent discussing toe amputation risks and postoperative wound care. The procedure 28153 (removal of the condyle at the distal end of the phalanx — distal phalanx amputation of a toe) is performed in an ambulatory surgery center or hospital outpatient department under local, regional, or general anesthesia. Intraoperative steps include digital block or regional block, excision of necrotic tissue, amputation through the distal phalanx condyle, hemostasis, and primary closure or delayed primary closure depending on tissue viability. Postoperative workflow includes dressing and offloading instructions, short-course antibiotics if infected, pain control, wound checks at 48–72 hours, and coordination with primary care or podiatry for gait training and footwear modification. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When additional distinct procedures are billed the same day by the same provider and is not the primary procedure. |