Summary & Overview
CPT 28175: Radical Resection of Phalanx for Tumor
CPT code 28175 denotes radical surgical resection of a phalanx to remove a tumor, commonly used for malignant lesions of the finger or toe that require excision with wide margins. This code represents a definitive surgical intervention that can be limb-preserving when feasible or may be part of staged oncologic care pathways. Nationally, the code matters because it captures resource-intensive operative management, informs provider payment for specialized orthopedic and hand surgery services, and factors into utilization patterns for musculoskeletal oncology.
Key payers covered in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, settings where the service is delivered, and what the code represents in claims data. The publication also outlines relevant benchmarks and policy considerations that affect coding, prior authorization, and reimbursement for complex surgical oncology services. Where input data are unavailable, the text notes: "Data not available in the input."
Billing Code Overview
CPT code 28175 describes the surgical removal of a phalanx bone and surrounding tissue to excise a tumor. The procedure typically involves radical resection for malignant lesions, removing the affected phalanx and a wide margin of adjacent normal tissue to reduce the risk of residual malignant cells.
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Service type: Surgical tumor resection of a phalanx (radical resection)
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Typical site of service: Operating room or ambulatory surgical center, often performed by orthopedic oncology or hand surgery specialists
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents with a progressively enlarging, painful mass at the distal phalanx of the right middle finger. Imaging (plain radiographs and MRI) shows a lytic lesion involving the distal phalanx with cortical destruction and soft-tissue extension; biopsy confirms a malignant primary tumor of the phalanx. The orthopedic hand surgeon schedules a radical resection of the affected phalanx and surrounding soft tissue to achieve wide margins.
The clinical workflow includes preoperative evaluation (history, focused hand and neurovascular exam), imaging for local and regional staging, tissue diagnosis by core or incisional biopsy, multidisciplinary review with oncology and pathology, informed consent discussing risks and functional impact, scheduling for operative removal of the involved phalanx (digit-sparing or amputation level determined intraoperatively), intraoperative margin assessment, possible reconstruction or soft-tissue coverage, postoperative monitoring for wound healing and infection, and referral to oncology for adjuvant therapy if indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When radical resection is performed on corresponding phalanges of both hands (rare). |
62 |