Summary & Overview
CPT 28531: Open Treatment of Sesamoid Bone Fracture
CPT code 28531 represents the open surgical treatment of a fractured sesamoid bone in the foot, performed with or without internal fixation. This code captures a specialized podiatric/orthopedic procedure that addresses painful or unstable sesamoid fractures that do not respond to conservative care. Nationally, accurate coding for this procedure affects surgical episode classification, payer authorization, and claims adjudication for foot and ankle surgical services. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on when open sesamoid fracture repair is reported, typical sites of service (hospital operating room or ambulatory surgical center), and operational implications for billing and documentation. The publication also outlines common modifiers and payer considerations used in practice, benchmark points for payment and utilization where available, and recent policy or coverage trends relevant to surgical foot procedures. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 28531 describes the open treatment of a sesamoid bone fracture of the foot. The procedure involves surgical exposure and reduction of a fractured sesamoid, with or without internal fixation using implants such as pins or screws. Sesamoid bones in the foot are small, irregular bones most commonly located beneath the head of the first metatarsal, under the great toe.
-
Service type: Open surgical fracture repair of a sesamoid bone
-
Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 34-year-old recreational runner presents with acute medial forefoot pain after pivoting on the toe during a trail run. Physical exam reveals focal tenderness under the first metatarsophalangeal joint and pain with passive dorsiflexion of the great toe. Weightbearing and nonweightbearing radiographs demonstrate a displaced fracture of the plantar sesamoid. After failed conservative care (immobilization, protected weightbearing, and NSAIDs) and persistent pain with mechanical deformity on imaging, the patient is scheduled for an open treatment of the sesamoid fracture.
Preoperative workflow includes history and physical, informed consent specific to 28531 addressing risks of wound complications and possible hardware removal, anesthesia evaluation (regional block or general), and preoperative imaging review. Intraoperative steps include exposure of the sesamoid, debridement of interposed soft tissue, reduction of fracture fragments and, if indicated, internal fixation with small screws or Kirschner wires. Procedure may be performed in an ambulatory surgery center or hospital outpatient surgery setting. Postoperative workflow includes recovery from anesthesia, analgesia plan, instructions for partial weightbearing in a postoperative shoe or cast, wound care, and scheduled follow-up with radiographic evaluation to confirm healing and decide on hardware retention or removal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 |