Mountain State Medical Policy Bulletin
Section: Podiatry
Number: P-5
Topic: Hammer Toe Correction, Tenotomy, and Capsulotomy
Effective Date: August 1, 2005
Issued Date: January 30, 2006
Date Last Reviewed: 01/2006

General Policy Guidelines

Indications and Limitations of Coverage

A capsulotomy and surgery on a tendon performed in a single operative area should be processed for payment under the appropriate combined code. The combined foot codes are: 28261, 28262, 28270 and 28272.

If a provider reports a tenotomy, capsulotomy and hammer toe correction of the same interphalangeal joint, with a single charge, the claim should be processed under procedure code 28285 or 28286. Also, if an arthroplasty with hammer toe correction, tenotomy and capsulotomy are reported with a single charge, the claim should be processed under procedure code 28899. If the charges for each procedure are itemized, they should be processed in accordance with Medical Policy Bulletin S-100 (multiple surgical procedures).

Procedure Codes

282612826228270282722828528286
28899     

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

View Previous Versions

[Version 001 of P-5]

Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.