A patient presented with a left ruptured plantar plate, dorsal contracture with subluxation and ruptured flexor tendons of the second metatarsophalangeal joint. Both dorsal and plantar incisions were made over the second metatarsophalangeal joint. Through the dorsal incision, a capsulotomy was made and previously placed hardware was removed. Through the plantar incision, drill holes were created in preparation for the plantar plate repair with an InternalBrace™ and the use of Arthrex screws. Once the Fiber tape and anchors were placed, the flexor tendons were repaired by suturing the tendons into the distal portion of the repaired plantar plate at the base of the proximal phalanx. GraftJacket dermal allograft was placed from dorsal to plantar to over lay the degenerative second metatarsal head. It was then sutured into the plantar joint capsule and plantar plate correcting the metatarsophalangeal joint subluxation.
Is it appropriate to assign CPT codes 28645 and 28899 for dorsal subluxation repair of the metatarsophalangeal joint with internal brace and plantar plate repair with graft jacket?
Assign CPT code 28899, Unlisted procedure, foot or toes, for the repair of the plantar plate and CPT code 28270, Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure), with Modifier 59, Distinct Procedural Service, appended, for the dorsal subluxation repair of the metatarsophalangeal joint.
In addition, assign code 28200, Repair, tendon, flexor, foot; primary or secondary without free graft, each tendon, for the repair of the flexor tendon. The application of the GraftJacket allograft is inherent to the repair of the metatarsophalangeal joint subluxation and not separately reported. However, HCPCS Level II code Q4107, GRAFTJACKET, per sq cm, is reported to capture the use of the GraftJacket.
Also assign HCPCS Level II code C1713, Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable), to capture the Arthrex screws.
Although CPT code 28270 is designated a “separate procedure,” the capsulotomy was performed via the dorsal (separate) incision. CPT code 28270 is the correct code assignment when a subluxated joint repair is performed dorsally.
Please note, when reporting unlisted codes, submission of medical record documentation may be required.