Summary & Overview
CPT 28345: Incision of Connective Tissue Between Fused Digits (Syndactyly)
CPT code 28345 represents a surgical procedure to incise the connective tissue (web) between fused digits for treatment of syndactyly; skin grafting, when performed, is included. This code is relevant nationally for pediatric and reconstructive hand and foot surgery, affecting surgical practice patterns, facility workflows, and payer coverage decisions. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise review of what the code denotes clinically, common sites of service, and the typical surgical context. The publication summarizes payer coverage considerations and common modifiers used with this CPT code, offers benchmarks where available, and highlights policy or billing practice implications relevant to providers, facilities, and billing professionals. Clinical context covers indications (syndactyly repair), procedural scope (one web at a time, inclusion of skin grafts), and expected care settings (operating room or ambulatory surgical center). Policy and billing sections address how payers may handle authorization, bundling, and documentation expectations for reconstructive digit separation procedures. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 28345 describes the surgical incision of connective tissue (web) between fused digits, performed one web at a time to correct syndactyly. The procedure includes any required skin graft when performed as part of the same operation.
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Service type: Surgical procedure for hand/foot reconstruction to separate fused digits (syndactyly release)
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Typical site of service: Hospital operating room or ambulatory surgical center, depending on case complexity and patient factors
Clinical & Coding Specifications
Clinical Context
A 2-year-old child presents to a pediatric plastic surgery clinic with congenital syndactyly of the second and third fingers of the right hand, causing limited finger separation and difficulty with grasping. After clinical evaluation and preoperative planning, the patient is scheduled for surgical release under general anesthesia. The operative workflow includes preoperative marking of the web space, regional or general anesthesia induction, a tourniquet as needed, longitudinal or zigzag incision to separate the fused digits, meticulous dissection of subcutaneous tissue and any fibrous bands, and primary skin closure. If soft-tissue deficiency is present after separation, a full- or split-thickness skin graft may be harvested (skin graft is included in 28345). Postoperative care includes dressing application, hand immobilization in a splint, analgesia, wound checks, and follow-up for range-of-motion therapy and scar management. Typical sites of service are an ambulatory surgery center or hospital outpatient surgery department. Payors commonly involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for 28345 (document rationale). |