Claw Toe

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April 9, 2015

Question:
We are having some debate about whether CPT code 28285 (hammertoe repair) would be appropriate for fusion of a claw toe? The claw toe is the DIP joint; the hammertoe is the PIP joint. However, code 28285 does not specify which interphalangeal joint is corrected. Should we report 28285 or an unlisted code?

Answer:
A: Thanks for your inquiry. As you note, CPT does not specifically state which joint; it says “e.g., interphalangeal fusion.” The “e.g.” directs us that this is only an example. Therefore, CPT code 28285 is the correct code, assuming the documentation supports the work described by 28285. You will note in Code-X that the claw foot and claw toe diagnosis codes support the medical necessity to report CPT code 28285.