Summary & Overview
HCPCS Level II C7566: Interphalangeal Joint Arthrodesis with Autograft
HCPCS Level II code C7566 denotes arthrodesis of interphalangeal joints performed with autograft material and may include internal fixation. This code captures a specialized orthopedic surgical service used to fuse small joints in the fingers or toes to alleviate pain, correct deformity, or stabilize joint disease. Nationally, accurate use of this HCPCS Level II code matters for appropriate episode-level billing, surgical quality tracking, and reimbursement for procedures that include graft harvesting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for interphalangeal joint fusion, the typical site of service (outpatient surgical centers and hospital operating rooms), and how the code is used to document procedures that include autograft harvesting. The publication also summarizes available national benchmarks and policy considerations relevant to coverage and coding clarity, and highlights common areas for coding review and audit. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code C7566 describes arthrodesis of interphalangeal joints with or without internal fixation, performed with autografts, and includes the procedure to obtain the graft. The service type is surgical reconstruction of small joints in the hand or foot aimed at joint fusion to relieve pain or correct deformity. The typical site of service is an outpatient surgical center or hospital operating room where orthopedic or hand surgery procedures are performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with painful, unstable, or arthritic deformity of an interphalangeal joint (commonly of the toe or finger), often following advanced osteoarthritis, post-traumatic subluxation, or failed conservative management such as splinting, injections, and activity modification. The patient presents with localized joint pain, crepitus, deformity and impaired function that limits daily activities and footwear or manual tasks. Radiographs confirm joint space loss, osteophyte formation, and subchondral sclerosis.
The clinical workflow includes preoperative evaluation by an orthopedic hand or foot surgeon (or podiatric surgeon for toes), medical clearance, and imaging. On the day of surgery under regional or general anesthesia, the surgeon performs joint exposure, removal of cartilage and preparation of opposing bone surfaces, placement of an autograft (harvested from local site or separate harvest site) and internal fixation as needed to achieve fusion. Postoperative care includes immobilization in a splint or boot, wound checks, activity restrictions, and follow-up radiographs to document fusion. Rehabilitation focuses on wound healing, gradual return to weight-bearing or hand function, and monitoring for complications such as nonunion or graft site morbidity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When the procedure is performed on the left finger or left toe interphalangeal joint |