Summary & Overview
CPT 28496: Percutaneous Fixation of Great Toe Phalanx Fracture
CPT code 28496 denotes percutaneous fixation of a fracture of the phalanx or phalanges of the great toe using screws and/or pins, including manipulation of the fracture. This surgical code is relevant nationally for orthopedic and podiatric practices managing acute toe fractures that require internal stabilization. It captures a common, targeted operative approach that affects facility and surgeon billing, operative planning, and postoperative care pathways. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn clinical context for when the code is used, expected sites of service, and operational considerations for billing and claims adjudication. The publication provides benchmark context and policy-relevant details such as coverage considerations, typical utilization settings, and documentation elements that support code selection. Data not available in the input are noted where applicable. The summary equips clinicians, coding professionals, and payers with a concise reference to the clinical scope of CPT code 28496, its role in fracture management of the great toe, and the types of information to review when evaluating claims and coverage policies.
Billing Code Overview
CPT code 28496 describes surgical treatment of a fracture of the phalanx or phalanges of the great toe using percutaneous fixation with screws and/or pins. The procedure includes manipulation (adjustment) of the fractured bone and placement of internal fixation through the skin to stabilize one or more phalanges of the great toe.
-
Service type: Surgical fixation of great toe phalanx fracture (percutaneous internal fixation)
-
Typical site of service: Ambulatory surgical center or hospital operating room, depending on case complexity and patient needs.
Clinical & Coding Specifications
Clinical Context
A 32-year-old recreational soccer player presents to the urgent care clinic after sustaining a direct crushing injury to the right great toe during a game. The patient reports immediate pain, swelling, and inability to bear weight on the forefoot. Physical exam shows dorsomedial deformity of the right great toe, focal tenderness over the proximal phalanx, and limited range of motion. Plain radiographs reveal a displaced, unstable fracture of the proximal phalanx of the right great toe. Office-based or ambulatory surgical treatment is scheduled: closed reduction with percutaneous fixation using small-diameter screws and/or Kirschner wires under local/regional anesthesia with fluoroscopic guidance.
The clinical workflow includes pre-procedure evaluation (history, focused exam, informed consent), imaging review and surgical plan, procedural anesthesia (local digital block or regional block), closed manipulation and reduction, percutaneous fixation with screws and/or pins, intraoperative fluoroscopy to confirm reduction and hardware position, sterile dressing and immobilization (postoperative shoe or cast), postoperative instructions and scheduling of follow-up radiographs and pin removal if applicable. Typical documentation elements include indication, imaging findings, reduction maneuvers, devices used (screw/pin sizes and counts), laterality, anesthesia, estimated blood loss (usually minimal), and postoperative care plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |