Summary & Overview
CPT 28505: Open Treatment of Great Toe Phalanx Fracture
CPT code 28505 represents open surgical treatment of a fracture to the great toe phalanx (hallux), with or without internal fixation. This code is used for operative management of one or more phalangeal fractures of the hallux and is relevant across inpatient and outpatient surgical settings. Nationally, management of toe phalanx fractures contributes to musculoskeletal surgical volume and is an important component of orthopedic and podiatric procedural coding.
Key payers in the national review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, expected sites of service, commonly applied modifiers, and context for coding capture. The publication provides benchmarks for utilization and allowed amounts where available, summaries of payer policy themes affecting surgical fixation and facility setting, and clinical context to inform correct procedural reporting. The content is intended to clarify what CPT code 28505 represents, typical care settings, and the coding elements that influence reimbursement and claims adjudication. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 28505 describes the open treatment of a phalanx or phalanges fracture in the great toe. The procedure involves surgical exposure and reduction of one or more fractures of the proximal or distal phalanx of the hallux; internal fixation devices such as pins or screws may be used but are not required.
-
Service type: Surgical repair of toe phalanx fracture (open reduction)
-
Typical site of service: Hospital operating room or ambulatory surgery center, depending on severity and patient factors
Clinical & Coding Specifications
Clinical Context
A 34-year-old recreational soccer player presents to the emergency department after an acute inversion injury to the forefoot when another player stepped on the tip of the great toe. The patient reports immediate severe pain, visible deformity at the proximal phalanx of the great toe, and inability to bear weight on the foot. Initial evaluation includes focused history, neurovascular exam, and plain radiographs of the toe and foot demonstrating a displaced, angulated fracture of the proximal phalanx of the great toe. After closed reduction attempts in the ED fail to achieve stable alignment, the orthopedic or podiatric surgeon recommends open reduction and internal fixation.
Preoperative workflow includes informed consent, preoperative medical clearance as indicated, and routine perioperative prophylaxis (antibiotic and DVT risk assessment). The procedure performed is open treatment of a phalanx fracture of the great toe with possible internal fixation using pins or screws. Postoperative care includes immobilization in a postoperative shoe or cast, wound checks, weight-bearing restrictions, and radiographic follow-up to confirm fracture healing and hardware position. Rehabilitation includes progressive range-of-motion and gait training once healing is adequate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left great toe. |