2025 CPT code 28496
(Active) Effective Date: N/A Revision Date: N/A Surgery - Fracture and Dislocation Treatment Musculoskeletal System Feed
Percutaneous skeletal fixation of a fractured great toe phalanx or phalanges, with manipulation.
Modifiers may be applicable depending on the circumstances of the procedure. Consult current CPT guidelines for appropriate modifier usage (e.g., modifier 51 for multiple procedures, 76 for a repeat procedure, etc.).
Medical necessity is established when the fracture requires surgical intervention to achieve adequate alignment and stability, which is not achievable through non-surgical means.This may be due to the degree of displacement, comminution, or presence of articular involvement.
The orthopedic surgeon or qualified healthcare professional is responsible for the fracture reduction, percutaneous fixation, post-operative care, and follow-up.This may also include obtaining imaging to verify proper alignment.
In simple words: The doctor fixes a broken bone in the big toe using small screws and pins inserted through the skin. The broken bone pieces are put back into place before the pins and screws are inserted. The toe will be supported with a splint or brace afterwards.
This procedure involves the percutaneous skeletal fixation of a fracture in the great toe's phalanx or phalanges.The procedure includes manipulation (reduction) of the fractured bone fragments to restore proper alignment. Pins and screws are inserted percutaneously to stabilize the fracture.This is a percutaneous technique; therefore, the fracture site is not directly visualized or surgically opened.
Example 1: A patient presents with a comminuted fracture of the distal phalanx of the great toe after a crush injury.The surgeon performs closed reduction and percutaneous pinning., A patient sustains a displaced fracture of the proximal phalanx of the great toe following a sports injury.The fracture is reduced percutaneously, and K-wires are inserted for fixation., A patient presents with an avulsion fracture of the great toe's base, which is reduced with the use of a small incision for screw placement.
* Preoperative and postoperative x-rays.* Operative report detailing the fracture reduction technique, materials used, and any complications.* Anesthesia record.* Appropriate documentation of medical necessity.
** The specific pins and screws used are not coded separately unless unusual circumstances are present.Consider adding additional codes for any extensive soft tissue repair or associated procedures done.
- Revenue Code: P6B (Minor Procedures - Musculoskeletal)
- RVU: See the current year's Medicare Physician Fee Schedule for RVUs.The value will vary based on geographic location and other factors.
- Global Days : The global period will depend on the surgeon's practice and local policies.It is recommended to consult the surgeon's office for the specific global period. Note: the global period usually does not include additional procedures done during or after the period.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically applicable to this code as it represents the entire procedure.
- Fee Schedule : Historical fee schedule data can be found through various commercial medical billing resources,but it should not be considered definitive without confirming it against the most current and regionally applicable information.
- Specialties:Orthopedic Surgery, Podiatric Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient