2nd metatarsal joint replacement cpt2nd metatarsal joint replacement cpt

https://doi.org/10.1177/1071100718786494. The fixation is intramedullary (a novel spring fixation system for the metatarsal and a screw fixation for the phalangeal component) and the implant has high conformity and low constraint to withstand the stresses applied on it by walking and weight bearing, thus minimizing wear. inappropriate to use. The capsule is split longitudinally. A maximum of five units can be a bill on the same service date of toe amputation CPT codes 22820, 28825, or 28810. Clin Podiatry. A guide wire is driven into the metatarsal head to centralize the component in the shaft (Fig. This procedure can be combined with other procedures such as an osteotomy where the metatarsal diaphysis is shortened to separate the metatarsophalangeal joint By using this website, you agree to our The surgical technique was found to be simple and reproducible in the cadaver trial. Previously we reported 28293 when a hemi- or total joint arthroplasty was performed at the first metatarsophalangeal joint but that code was deleted in 2017 and replaced with 28291 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant. Osteotomies of the proximal phalangeal base have been reported to realign the second toe (17). Painful degenerative diseases of the second metatarsophalangeal joint are frequently progressive and difficult to treat. Radiographic appearance of the implant (antero-posterior and lateral views). 1989;1:113. <> Please keep in mind that an arthroplasty could be a hammertoe replacement (see code 28285 if necessary). gQEsSsAorL)'+ _'B>-Sy"NJLDY;sf&sN37Xej-MdiXK L_>%SY?xbR -ia(5E6"p;gm&F {{@MZd+(e(iFl\?jt.SoB5o#p, 29bN??oZ;tLVs12F1imsr#sD`4RJ7vSjO-Foxb#.,*Zv^dcJC `NNCGs1X67VcdYX J Am Podiatry Assoc. National Medical Billing Services Acquires mdStrategies, Vertebral Augmentation vs. Vertebral Body Stenting, Anterior and Posterior Lumbar Arthrodesis, Nerve Block Injection CPT Codes The Anatomy of Coding Series 2018, Knee Arthroplasty Procedures Anatomy of Coding September 2018, Joint Implants for the MTPJ August 2018, MACI (Matrix-Induced Autologous Chondrocyte Implantation) Webinar 2018. Response: There is no CPT code for this procedure. 3 - Cyclical testing instrumentation set-up). The reported cases are too few and short term to make recommendations for their use [18, 24]. They will even go so far as to try to negotiate a price per chart. Therefore, the only procedure that should be billed is the first metatarsophalangeal joint arthrodesis, CPT code 28750. there was still contracture at the 2nd MPJ and a metatarsal capsulotomy and tenotomy was made through a 2nd transverse incision at the joint . [2] Patients usually present with a painful and often swollen joint. Role of plantar plate and surgical reconstruction techniques on static stability of lesser metatarsophalangeal joints: a biomechanical study. 2023 BioMed Central Ltd unless otherwise stated. 1988 Aug;9(1):10-8. doi: 10.1177/107110078800900104. This company borders on total harassment. endstream endobj 603 0 obj <>stream The metatarsals are numbered one through five, starting with the big toe. Part of Arthritis of the first metatarsophalanageal joint (MPJ), or hallux rigidus, is the most common arthritic condition in the foot and ankle. A cap applied just to the metatarsal head (hemiarthroplasty) -essentially a "half a joint replacement. While you may be hesitant to code CPT 28285 for any deformity described with a term other than hammertoe, we can code CPT 28285 with confidence since we have a reference from the AMA supporting that coding4. Y?3.i(HC_HZlhm"p(PQT!&,0|`P^a ``` @6 QuE@ H+X$y nz?;t8x/l`>}A Large contact area is achieved between the component and the subchondral bone by virtue of the flat resection of the bone and the flat surface of the component. H\0~ The audio visual format need not be HIPAA compliant, thus the use of Facetime, Zoom, Google Meet are all fair game. Left and right arrows move across top level links and expand / close . ?F6@2*Z*JQ!Fa|G~ q xR5,PAEm4pq;W.V@|K=O}UuS[}]s;Rw-lj|amji/aSCs:6N5!|~7eYZjXmT7E w. Foot and ankle coding overview - American Academy of Orthopaedic Surgeons CPT 28299 revised Correction, hallux valgus (bunion), with or . The distal end of the plantar plate inserts into the base of the proximal . Radiographs of living subjects were used to measure the medullary diameter of the metatarsal and proximal phalanx. L Tarsometatarsal Joint, Left M Metatarsal-Phalangeal Joint, Right N Metatarsal-Phalangeal Joint, Left P Toe Phalangeal Joint, Right Q Toe Phalangeal Joint, Left Open 4 Internal Fixation Device 8 Spacer Z No Qualifier Reposition (Moving to its normal location, or other suitable location, all or a portion of a body part. Stay the course. 2015;54(2):23741. CAS Is there a modifier for submitting related charges for necessary services? That has apparently gone by the wayside. Thompson FM, Hamilton WG. When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier -78 to the related procedure. The implant is considered to be more of a resurfacing rather than a metatarsal head replacement so as not to interfere with the plantar condyles of the metatarsal head. PDF code it SWANSON It depends on the contracts. Eight patients reported good or excellent results [30]. I performed removal of bone spurs on the four lesser toes of the right foot (CPT 28108). Measurements were carried out with a TESAMASTER Standard High Precision Micrometer with Digital Counter reading down to 1 and the water was assessed for polyethylene particles. If this procedure is done in conjunction with a Hammertoe (28285) procedure, it would Comparison of the effects of forefoot joint-preserving arthroplasty and Early-stage findings may be nothing more than plantar distal sulcus pain, with no/minimal digital deformity, first described by Yu as predislocation syndrome (, The most common sign of a ruptured plantar plate is the weight-bearing appearance of the second toe. 2008;1(2):857. Tintocallis CA. Harkless LJTJ. endobj anschutz canada dealer. Instead of a transverse ligament between the 1st and 2nd metatarsal, there are plantar, interosseous, and dorsal oblique ligaments that runs from the medial cuneiform and the base of the 2nd metatarsal. <. Cite this article. An integral part of the procedure is the soft tissue balancing of the joint. CPC, COC, CPC-P, COSC, CASCC What is the CPT code for Arthroplasty interphalangeal joint toe? The mobile bearing is likewise unique in its attachment to the phalangeal component in that it is a completely rotating platform which allows a certain amount of multidirectional gliding and a wide range of motion. CPT 99202-CPT 99205) with a -95 modifier. RE: Aetna Medicare Advantage (Jeffrey Kass, DPM). I just received reimbursement for a hallux amputation for a patient I managed while they were admitted to the hospital. Yes, I win every time, but I have to appeal over and over again. The goals of operative treatment are correction of the deformity and rebalancing of the deforming muscle forces. Demographics. This procedure uses a small, two-piece implant to cover damaged or missing articular cartilage in the MTP joint, where the base of the great toe meets the foot. Group1 included 22 feet of 11 healthy controls (age 48.6 . APMA and AMA should demand a cost of living increase of 5 percent from this health plan and others. The phalangeal fixation is of the screw in type. Range of motion and stability was tested using custom made instrumentation in four cadavers. Metatarsal joint implant: Other HCPCS codes related to the CPB: J0702: . Dismiss. Vertical cut angle reduces potential for dorsal impingement. Lesser metatarsophalangeal joint arthritis (primarily Freibergs infraction and post traumatic), may require surgical intervention once conservative management fails. 2012;30(12):19958. Many people who have undergone arthroplasty report . Our office now has to print the medical claim, attach medical notes, and send the old fashioned way as opposed to sending claims electronically. If you are a member and have already registered for member area and forum access, you can log in by clicking here. 1 - Lesser metatarsophalangeal joint implants). 2023 CPT Changes for Surgery Now Available - click on Shop to learn more! Lavery L, Harkless LJTJ. Six of these patients had Freibergs infraction. The idea of a total LMTPJ replacement arthroplasty remains a feasible option for the isolated arthritic LMTPJ. Privacy If claim denials based on these edits are appealed, MACs may pay UOS in excess of the MUE value if theres adequate documentation of medical necessity of the reported units. One case required a custom implant. This CPT code has a post-operative global period of 0 days. These joints are subject to severe repetitive fatigue loading over small articulating surfaces through a wide range of motion. Implant arthroplasty of the lesser metatarsophalangeal joint a modified technique. The metallic components are made of titanium with a grid blasted under surface for maximum bony ingrowth. I did suggest APMA get to threatening the health plan with exposure and recommending legal action, class actions, etc. Myerson MS, Kadakia AR. PubMed The implants were subjected to 5 million cycles, after which wear damage at the contact surface of each implant was captured by means of photographic imaging and thickness measurements of the meniscus. I suggest the following: APMA members should submit their good notes with the EOMBs to APMA. other diagnoses such as. Google Scholar. 0 Anthem denied both claims stating invalid modifiers. The Swanson prosthesis, originally designed for the hand, has been used for the LMTPJs [17,18,19,20,21,22,23,24,25]. Shih AT, Quint RE, Armstrong DG, Nixon BP. The objective of this study is to design an effective replacement arthroplasty of the second and third metatarsophalangeal joint for end stage arthritis or symptomatic Freibergs infraction to add to the armamentarium of the foot and ankle surgeon. Notice, though, that in the parentheses of the code description for CPT 28285, we have an e.g., listed before those procedures. Just like everyone else, we do not have the staff or time to keep doing these. Have you been billing E/M providing the patient with an evaluation and medical management post amputation? volume22, Articlenumber:424 (2021) Because our toes have three phalanges, we have two interphalangeal joints. The first metatarsophalangeal joint arthrodesis could not be performed unless the implant was first removed from the first metatarsophalangeal joint. Considering published articles regarding cadaver utilization, this research presents an in vitro study which utilized 15 cadavers, culminating in six cadavers in the final stages (four for technique and measurement testing and two for assessment of surgical technique and X-rays by an independent foot and ankle surgeon). There are no more messages in this thread. The ASC needs to add codes 28270-59-T1 and 28270-59-T2 [capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)]. Maybe we should start telling our patients to switch plans to avoid us from charging them what the health plan rejects. This is an in vitro and cadaver study of a new design replacement arthroplasty developed by the senior author. 'Yr;\(0Ei(#`a ]pw LUZ[(\p6(p0%i;]Pu 5 Hallux disarticulation for application of electro-goniometer). Carmont MR, Rees RJ, Blundell CM. The surgical repair or replacement of a diseased joint is known as arthroplasty. Often the arthritis is isolated to one joint and commonly due to previous trauma or Freibergs infraction. Arthrodesis of an osteoarthritic second metatarsophalangeal (MTP) joint is suboptimal because of altered gait mechanics; hence, joint-preserving procedures are of value. Excision of the phalanges or fusion of the interphalangeal joints will help the toe to lie flat again and not pop back up after surgery. Significant wear was evident on all four inserts after testing at excessive forces (Fig. All nine patients were female with a mean age of 51years. The indication for surgery is when this joint has a fixed curved (Clawtoe or Hammer Toe) deformity and when the deformity is producing enough pain or functional limitations to warrant surgery.The deformity develops gradually and cannot be straightened because it is . The amputation code you used is not stated, but for a toe there are two CPT codes: 1) CPT 28820-Amputation, toe; metatarsophalangeal joint. 660 0 obj Severe subluxation or dislocation of the 2nd MTPJ was present in 26 of 32ft. None of the Freibergs infraction group had significant deformity. The wording, "hallux valgus (bunion)" sets up, in my mind, an "either/or" condition for meeting CPT 28293 definitional requirements. https://doi.org/10.1007/s00167-006-0189-4. The implant alone is by no means the stabilizing factor. Healthfirst is asking for a more appropriate CPT code that should be used to bill for the service provided. The code we used was CPT 17110. 6 - Guide wire placement in the metatarsal). The Nicolle, the Calnam-Nicolle and the Niebauer-Cutter hinged prosthesis had been adapted for LMTPJ arthroplasty. Some insurance companies have their own criteria for authorization, such as only one injection on a date or only one injection in 6 months or other limitations like that. 1CPT Assistant, March 1, 2015, copyright American Medical Association, 2CPT Assistant, September 1, 2010, copyright American Medical Association, 3CPT Assistant, September 1, 2011, copyright American Medical Association, 4CPT Assistant, June 1, 2016, copyright American Medical Association, It's a New Year with New CPT Codes. CPT 28200 Repair, tendon, flexor, foot; primary or secondary without free graft, each tendon & CPT 28308 Osteotomy, with or without lengthening, shortening, angular correction, metatarsal; other than first metatarsal, each & CPT 28285 Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy) 22 The article is part of a PhD dissertation at the University of the Witwatersrand, Johannesburg, South Africa. '1>ca`xAZ!>/020-Y { The only good news about this situation is that the MUE Adjudication Indicator (MAI) is 3. I initially billed CPT 28810 and then subsequently CPT 13160. Toe Amputation CPT (2022) Description, Guidelines, Reimbursement Google Scholar. HWnF}Wh}Yy4Mc AHrD]Sv")b9svv|apT&*J?Es6ADYYx_ ;\&$+*c%,F^ZXg{L\Z+P6T9@]kJ9d>u[ct.h\E?z|M?8BbMg&d&!e6 fH[WuA,4]gW| Furthermore, we should all write letters to the U.S. Department of Labor asking them to take sanctions and fines for such abuse! 0d vRC]^J+!&TzVM+M]e9~(_RGGI9trpe"Th# RP3T`hj%{OAeQ Are any other practice having issues with United Health Care/Oxford and The Empire Plan when billing for E/M codes? J Foot Surg. Lets start with the CPT definition of CPT 28285 before looking at some references from CPT Assistant that will further clarify what services are included in this code and what may be separately reported. It was found that by using two phalangeal screw sizes, 98% of the adult population was accommodated. Policy Aetna considers the following procedures medically necessary for persons with disabling arthritis of the first metatarsal phalangeal joint (hallux rigidus): This novel LMTPJ replacement arthroplasty has been developed to fill the void of replacement arthroplasty options in the isolated arthritic LMTPJ. 2009;30(2):16776. There is no CPT code for toe arthroplasty; instead, use the unlisted procedure code 28899. This means that excision of the phalanges or interphalangeal fusion are just examples of the types of procedures that may correct a hammertoe. . This continues to be a fluid issue with every 90 days requiring a renewal of the PHE, thus restarting the clock on when the PHE ends and when the waivers terminate. the metatarsal head and removal of part of the proximal phalanx, leaving a flexible joint [e.g., Keller's arthroplasty]), arthrodesis (i.e., excision of the metatarsal head along with part of the proximal phalanx, and fusion of the joint), and implant arthroplasty (i.e., partial or total joint replacement with an artificial implant). The average dorsiflexion was 28.5 and 28.9 pre- and post-implant respectively. /g#ABHdF?j H ,Rm4:W}!|G'Uzq~K,_iVMu wV00Ngk{x,Oub/x%[x]2t&GxOej8EY)t/_l[\BmUpI.l&z"W`C6`!2]7777/E5Y,X[[YYYYYYXX:X83 The cadaveric specimens were utilised as part of specialised foot and ankle training workshops run by the authors; the specimens were obtained through standard procurement processes with all necessary permissions. This procedure may be considered when conservative treatments no longer provide adequate relief from joint pain and/or disability. Foot Ankle Spec. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 1992;3(1):16-24. MAI 3 indicates a value adjudicated by claims processing systems at the date of service level. Through the dorsal incision, a capsulotomy was made and previously placed hardware was removed. Any suggestions? August 2018. Reconstructive foot and ankle surgery: management of complications: Ebook. If you work in an orthopedic surgery or podiatry practice, chances are you have coded your fair share of hammertoe repairs. Its not your fault this the service is covered or not. Total knee replacement (arthroplasty) 27447. Other conditions that should be considered, in descending order of frequency, include, but are not limited to, distal metatarsal stress fracture, Frieberg disease/osteonecrosis, systemic/autoimmune arthritis (rheumatoid, psoriatic, etc. Ud:("9;79X}A]2O~V}}VJe 1988;9(1):108. I am not sure where you compared these two but on the. J Foot Surg. What this last statement indicates is that at the present time, you are not required to be in an area where telemedicine issues required HIPAA-compliant software nor you and your patient in a specific geographic area. When billing an unlisted code, the payer reviewer first will need to approve or deny the claim. described a case study using a titanium hemi-implant of the proximal phalanx. And, that in the course of preparing the site for the implant, the 1st metatarsal-phalangeal joint is remodeled with all the excess bone resected - medial, dorsal, and lateral. Ed Prikaszczikow, DPM, Council Bluffs, IA, Query: Lapidus Bunionectomies and Anthem Blue Cross. Part 2: quantification of the dynamic distribution. Etiology. A further two devices were then implanted in fresh frozen cadavers by an independent foot and ankle surgeon. Treatment of Freibergs infraction with the titanium hemi-implant. Both dorsal and plantar incisions were made over the second metatarsophalangeal joint. 29827. Google Scholar. Remember, a hammertoe is a deformity of the interphalangeal joint so . 1982;21(1):5760. Some will present in their senior years having a long-standing untreated bunion and overlapping second toe that simply wont fit into a shoe. No measurements were performed hence there was no need to amputate the hallux. Now for the last few months, the code is being denied. While hammertoe repairs are routine procedures for podiatrists, not all operative reports for a hammertoe repair read the same because there are different combinations of surgical procedures that may be required to correct the hammertoe, depending on the severity of the deformity. The metatarsal component is then inserted into the metatarsal head and gently impacted in place (Fig. The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, 2192, South Africa, Nikiforos P. Saragas&Paulo N. F. Ferrao, Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa, Netcare Sunninghill Hospital, Suite 3A, -2 Level, Westwing, Cnr Nanyuki & Witkoppen Road, Sunninghill, Johannesburg, 2157, South Africa, You can also search for this author in J Foot Ankle Surg. If you feel it is still part of the original chronic ulcer, then L97.4- or L97.5- depending on the anatomical location of the current ulcer being debrided. The authors declare that they have no competing interests. Not only does this code allow for reporting of the hemi- and total arthroplasty implants but basically any other type of implant placed in the joint space such as Cartiva (synthetic cartilage plug) or Arthrosurface Hemi-cap implants which are not joint replacement implants. Needless to say, I do not send any charts unless the invoice gets paid. In a series by Cracchiolo, 31s MTPJs in 28 patients were replaced by a double-stem silicone implant and a single-stem in one. CPT Chapters 15 (Step-by-Step Medical Coding) Flashcards Osteochondritis dissecans treated by joint replacement. Article | Outpatient Surgery Magazine - Association of periOperative At the final cadaver trial stage when the final product was tested, four cadavers (four toes) were used. All authors have read and approved the manuscript. The closure left an area open due to soft tissue deficit. The interpositional arthroplasty procedure in treatment of degenerative arthritis of the second metatarsophalangeal joint. Correspondence to <>stream This code is used is the joint capsule released lies between the tarsal and the toe. What a travesty to the patients, the doctors providing them, and the system. It may be from normal motion with no crepitation to rigidity of the toe and MTPJ. interphalangeal fusion, partial or total phalangectomy) Insurance companies are basically a legal means of extortion. But again, the patient knew these costs before signing the contract. PDF Foot and Ankle Systems Coding Reference Guide - Zimmer Biomet The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. 5th metatarsal most commonly fractured in adults. Foot Ankle Int. J Foot Surg. Pfeiffer WH, Cracchiolo A 3rd, Grace DL, Dorey FJ, Van Dyke E. Double-stem silicone implant arthroplasty of all metatarsophalangeal joints in patients with rheumatoid arthritis. Previously we reported 28293 when a hemi- or total joint arthroplasty was performed at the first metatarsophalangeal joint but that code was deleted in 2017 and replaced with 28291 - Hallux rigidus correction with cheilectomy, debridement and . The four implants each with the respective compressive forces as well as the sizes after completing 5,000,000cycles at physiological forces. L3010 RT KX and L3010 LT KX always got reimbursed until recently. The implant may be used as a total or hemi arthroplasty. Hammertoe Repair - Medical Clinical Policy Bulletins | Aetna A dorsal longitudinal midline incision centred over the lesser metatarsophalangeal joint is made. Is there any course of action as a practitioner? Epidemiology. All results quoted were from studies with a small number of patients to make any strong argument for favoring any of the procedures described meaningless. This procedure is commonly used to treat hallux rigidus, also called stiff big toe. All Cadaver parts were donated for research purposes Protocol number M180380 Ref: W-CJ-140813-1 (13-08-2014). Interposition arthroplasty as treatment of osteochondritis of the second metatarsal head. Prior to the measurement, the LMTPJ was taken through several cycles in order to reach a point of resistance by the same examiner. Joint replacement arthroplasty has been used in the end stages of the disease [16]. First MTP Joint Resection Arthroplasty | FootCareMD In contrast, the three units allow documentation supporting the service's medical necessity. We performed a destruction of a painful wart in the clinic. { O9#)6RK':h. At an average follow-up of 37months, a good subjective result was recorded in 63% and good with reservations in 25%. The process is taking much longer for reimbursement. 2013;34(10):143642. Toe Amputation CPT Reimbursement. Payer rules related to modifiers further complicate the claims submission process and increase the challenges faced by the appeals team. Stick with the T modifiers, since these are the most appropriate modifiers to use. https://doi.org/10.7547/87507315-69-9-556. PDF Coding for First Ray Surgery - apma.org Each time a practice takes the time to send the appeal letter in, it is costing you money to do so and in the process reducing the payment one receives. . Many of the arthroplasty implants are considered experimental/investigational and not covered by the patients policy. It's not that I have reason not to trust the billing company, but getting a copy in writing is always best. Both have a 0 day global period which means any care after the amputation day is an E/M. The APMA lawsuits of years ago focused on changing codes, transparency of policies, and clear directions from the payers. %%EOF We are DME certified suppliers. The 3rd TMT joint is in line . For many years, we were using J0702 for Celestone injections and getting paid. A claw toe deformity is similar to a hammertoe because the interphalangeal joint is bent upwards, but claw toes dig down into the sole of a shoe and can create calluses as a result: Claw Toe Deformity AAOS. hb```b``6f`e`` @16< peak incidence between 2nd and 5th decade of life. Total hip replacement for the treatment of severe osteoarthritis. Zgonis T, Jolly GP, Kanuck DM. To that end, I would include in the letter of explanation a suggested comparison code of equal work and value. Some of their calls even appear on the caller ID as Spam. For my visual learners, check out this image of a hammertoe: Hammertoe. I have tried to look up codes and asked around but have not come up with a good option. This procedure stops pain by preventing the surfaces of the big joint of the big toe from rubbing together. PubMedGoogle Scholar. Scartozzi G, Schram A, Janigian J. Freibergs infraction of the second metatarsal head with formation of multiple loose bodies. 11 - Electrogoniometer for range of motion measurement). Are we obligated to do them by our payor contracts? Teich LJ, Frankel JP, Lipsman S. Silicone hinge replacement arthroplasty. The definition shows it is a partial excision of bone of the fibula. Screw implanted in proximal phalanx for the purpose of stability testing. Single piece implant. Remind the patient that the rules are from THEIR insurance company. Second Metatarsophalangeal Joint Interpositional Arthroplasty Using $"j/Fr If I have a $250 co-payment for every visit to the ER, I pay $250, even if they tell me to go home and call a podiatrist for the ingrown toenail. Female and male skeletons were included randomly from the anatomy department. I cannot find any information of new modifiers or other info needed. 12 - Screw implanted in proximal phalanx for the purpose of stability testing). A number of implants of various sizes were manufactured for the purpose of the study. Lawrence BR, Papier MJ. May 2020. On average the subluxation stability of the intact joints is around 25N in a dorsal or superior direction and approximately 16N in dorsiflexion [32, 33] (Fig. 3) The 1135 waivers are in place for a period not less than 151 days after the end of the PHE or through the end of Calendar year 2023 or two years after the end of the PHE. Depending on the stage of deformity, signs and symptoms will vary at the initial time of presentation. We link the acquired deformity of bone diagnosis to CPT 28308.". 8 - Metatarsal component in place). The one I am most interested in is the AMA's response since I am curious as to what the AMA's original intent was when CPT 28293 was introduced if not to primarily treat conditions of 1st metatarsal-phalangeal degenerative joint disease with joint resection and a prosthesis as an alternative to joint fusion.
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