28122 CPT Code Reimbursement Explained

The CPT code 28122 is used to report partial excision of a tarsal or metatarsal bone, excluding the talus or calcaneus. This procedure is commonly performed on the fifth metatarsal for conditions like:

• Osteomyelitis
• Bone bossing
• Nonunion fracture

Key Points About CPT Code 28122

• Used for partial excision of the fifth metatarsal or other tarsal/metatarsal bones (except talus or calcaneus)
• Excision procedures remove a portion of the bone
• Commonly performed for osteomyelitis, fracture nonunion, bone bossing
• Global period is 90 days including day of surgery
• Modifier 59 may be appended for separate excision of multiple bones

Typical Procedures Reported with 28122

Some examples of procedures reported with CPT 28122 include:

• Partial excision of fifth metatarsal for osteomyelitis or nonunion fracture
• Metatarsal bone craterization or saucerization
• Sequestrectomy to remove dead bone fragments
• Partial diaphysectomy of metatarsal shaft

Understanding Osteomyelitis and Nonunions

CPT 28122 is often used to treat complications like osteomyelitis and nonunion fractures:

• Osteomyelitis – infection of the bone caused by bacteria. Partial removal of infected bone is needed.
• Nonunion fractures – a broken bone that fails to heal properly. Excision of the nonunion site encourages new bone formation.

Removing diseased or damaged sections of bone can help treat these conditions when antibiotics or surgical fixation have failed.

Correct Coding Guidelines

Follow these coding guidelines for CPT 28122:

• Report 28122 for each metatarsal or tarsal bone separately excised
• Append modifier 59 when excising multiple bones
• Includes bone grafting or insertion of antibiotic beads/implants
• Not reported with amputation codes (28800-28825)
• Has a global period of 90 days

Related Partial Excision CPT Codes

Other codes for partial excision procedures on the foot include:

• 28090 – Excision, tarsal or metatarsal bosses
• 28108 – Excision or curettage of bone cyst or benign tumor, tarsals or metatarsals
• 28119 – Ostectomy of calcaneus
• 28120 – Partial excision of bone, tarsals or metatarsals
• 28124 – Excision of Morton’s neuroma
• 28126 – Excision of lesion of metatarsal bone

Tips for Proper Coding

To ensure proper coding with CPT 28122:

• Accurately document the specific bone excised and amount of bone removed
• Specify the underlying condition like osteomyelitis or nonunion fracture
• Clarify if multiple bones underwent separate excisions
• List any bone grafts, antibiotics beads, or hardware inserted
• Note any additional procedures like skin flaps or repairs performed

Proper documentation and code selection is key to reporting partial metatarsal bone excision procedures. Ensuring the CPT code reported accurately reflects the procedure performed will avoid delays in claim processing and reimbursement.