Summary & Overview
CPT 28340: Soft-Tissue Resection and Reconstruction of Toe
CPT code 28340 covers surgical resection of excess soft tissue from an overly large toe to reconstruct it to more normal dimensions. The procedure addresses cosmetic and functional concerns related to soft-tissue hypertrophy of the toe and is commonly performed in outpatient surgical settings. Nationally, procedures coded with 28340 are relevant to foot and ankle surgeons, podiatrists, and ambulatory surgery centers, with implications for coverage, appropriate coding, and quality measurement.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for soft-tissue toe reconstruction, typical sites of service, and the common procedural setting. The publication summarizes billing and coding considerations relevant to 28340, highlights payer coverage patterns and benchmarks where available, and outlines policy or guideline changes that affect surgical foot procedures.
This analysis is intended to help billing professionals, clinical leaders, and policy staff understand the role of CPT code 28340 in surgical foot care, what to expect in terms of reimbursement environment and payer coverage, and where to look for additional documentation or policy guidance. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 28340 describes resection of soft tissue from an overly large toe to reconstruct it to more normal dimensions. The procedure is a surgical soft-tissue reconstruction of the toe, typically performed to reduce soft-tissue bulk and restore a more normal toe contour and function.
Service Type: Surgical outpatient or ambulatory soft-tissue procedure
Typical Site of Service: Outpatient surgical center or hospital ambulatory surgery unit
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with an enlarged or hypertrophic lesser toe (commonly the second or third toe) causing pain, footwear difficulty, recurrent soft-tissue irritation, or interdigital maceration. Conservative measures such as shoe modification, padding, toe spacers, and corticosteroid injections have failed. Evaluation includes focused foot exam, assessment of soft tissue and nail structures, weightbearing and non-weightbearing evaluation, and imaging if bone deformity or osteomyelitis is suspected. The surgeon discusses goals of soft-tissue resection to reduce girth and restore a more normal toe contour while preserving function.
Preoperative workflow includes informed consent, preoperative medical clearance as indicated, marking the operative toe, and local or regional anesthesia with or without monitored anesthesia care. Intraoperative steps typically involve a transverse or longitudinal incision over the involved soft tissue, careful dissection and resection of hypertrophic subcutaneous tissue, trimming of excess skin and callus, hemostasis, possible limited release of adhesions, and layered closure. Postoperative care includes dressing and immobilization, analgesia, wound care instructions, limited weightbearing in a postoperative shoe, and a follow-up visit for suture removal and assessment of wound healing and toe contouring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit for the evaluation and management services by the same physician during postoperative period |