🦴 CPT 28160 — Hemiphalangectomy Or Interphalangeal Joint Excision, Toe, Proximal End Of Phalanx, Each
Quick Reference
wRVU: 3.02 (flag for CY2026 MPFS confirmation) | Global Period: 090 | Assistant Payable: Yes | Bilateral Indicator: 1 Rule: This code carries a 90-day global surgical period, meaning all routine postoperative care through day 90 is bundled into the single payment. The bilateral indicator of 1 means standard bilateral payment reduction rules apply when the identical procedure is performed on corresponding toes of both feet in the same session. Because the descriptor already specifies “each,” this code is reported once per toe treated, so multiple toes in the same foot are billed as separate line items with modifier -59 or an appropriate X-modifier rather than -50.
📋 Clinical Description
CPT 28160 describes the surgical excision of the proximal end of a toe phalanx, the interphalangeal joint itself, or both, performed to remove diseased bone or joint tissue while leaving the remainder of the digit intact. The surgeon incises over the affected interphalangeal joint, isolates the proximal phalanx, and removes either a hemiphalangectomy segment (partial bone) or performs a formal joint excision depending on the extent of pathology encountered intraoperatively. This code is distinguished from 28153, which addresses resection of the condyles at the distal end of the phalanx rather than the proximal end, and from 28124, which is limited to partial bone excision techniques such as craterization or sequestrectomy that stop short of a true hemiphalangectomy or joint resection.
The most common indications driving selection of this code are chronic or acute osteomyelitis of the toe, painful bony exostosis or condylar hypertrophy at the interphalangeal joint, and rigid hammertoe deformity with joint-level pathology that has failed conservative management. When the procedure is performed as part of a staged hammertoe correction that also includes tendon work or joint stabilization, 28285 may be the more appropriate primary code, with 28160 becoming a bundled component rather than a separately reportable service.
This procedure may be performed in the following clinical contexts:
- Chronic osteomyelitis of the toe — segmental phalangeal or joint excision is performed to remove infected or necrotic bone that has failed antibiotic therapy alone.
- Painful interphalangeal joint exostosis — isolated bony overgrowth at the joint causing chronic pain and shoe-wear intolerance is excised without addressing the remainder of the digit.
- Diabetic foot complications with underlying osteomyelitis — bone excision is performed in conjunction with debridement of an overlying chronic ulcer to achieve source control of infection.
- Rigid hammertoe with joint-level deformity — when performed as an isolated joint excision rather than a full digital arthroplasty, this code applies; more extensive corrections map to 28285.
- Traumatic phalangeal injury with unsalvageable proximal segment — post-traumatic bone loss or comminution at the proximal phalanx may require formal hemiphalangectomy rather than simple debridement.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Hemiphalangectomy (bone-only) | The surgeon excises the proximal half of the phalanx while preserving the distal segment and surrounding soft tissue attachments, typically to eradicate osteomyelitic or exostotic bone. | Documentation must specify that a true hemiphalangectomy — not simple craterization — was performed, since the extent of bone removed is what separates this code from 28124 on audit review. |
| Interphalangeal joint excision | The joint capsule is opened, the articular surfaces are resected, and the joint space is debrided, effectively converting the interphalangeal joint into a fibrous non-articulating segment. | This approach is favored when the joint itself — rather than the bone alone — is the source of chronic pain or infection, and the operative note should explicitly describe joint resection rather than periarticular bone shaving. |
| Combined bone and joint resection | Both the proximal phalangeal segment and the adjacent joint surfaces are excised in the same operative session, typically for extensive osteomyelitis spanning the joint. | Only one unit of 28160 is billed per toe regardless of whether bone, joint, or both are addressed, since the code descriptor already encompasses either or both elements. |
Clinical Pearl
The single most important audit-defense element for this code is a clear operative note distinguishing “hemiphalangectomy of the proximal phalanx” or “interphalangeal joint excision” from lesser bone-shaving procedures like craterization or condylectomy. Payers routinely downcode ambiguous notes to 28124 when the extent of bone or joint removed is not explicitly quantified, so documentation should state the specific anatomic structure resected and the amount of phalanx remaining.
✅ Procedure Includes
- Preoperative evaluation and positioning of the affected foot and toe, including digital block or regional anesthesia administration.
- Local anesthetic infiltration or digital nerve block; general or MAC anesthesia is separately billable when used.
- The core excisional step — removal of the proximal phalangeal segment, the interphalangeal joint surfaces, or both, as clinically indicated.
- Intraoperative assessment of remaining bone stock and soft tissue viability to confirm adequate resection margins.
- Wound closure, dressing application, and immediate postoperative footwear or splinting instructions.
- Documentation of the specific toe, laterality, and extent of bone or joint removed to support code selection on audit.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 28124 | Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) of phalanx of toe | 28124 is reserved for lesser, partial bone-removal techniques that do not amount to a true hemiphalangectomy or joint excision; when the operative note describes only bone shaving rather than proximal segment or joint removal, 28124 is the correct code rather than 28160. |
| 28153 | Resection, condyle(s), distal end of phalanx, each toe | 28153 addresses the distal end of the phalanx, while 28160 addresses the proximal end; both may occasionally be reported on the same toe if truly separate distal and proximal resections are documented, but this is unusual and typically requires modifier -59 with clear anatomic justification. |
| 28285 | Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy) | Per NCCI, 28160 is bundled as a component into 28285 when both are performed on the same toe in the same session, since a formal hammertoe correction inherently includes any incidental joint or bone excision; 28160 is only separately reportable with modifier -59 when performed on a distinct toe or at a clearly separate anatomic site. |
| 28293 | Correction, hallux valgus (bunion), with or without sesamoidectomy; resection or arthrodesis | NCCI bundles 28160 into 28293 when performed on the same toe, since bunion correction procedures already contemplate any necessary bone or joint resection at that site; separate reporting requires documentation of a distinct toe or session. |
| E/M codes (992xx / 920xx) | Office visit, any level | Separately reportable only when modifier -25 is appended, documenting a significant, separately identifiable evaluation and management service beyond the routine pre-procedure assessment of the surgical toe. |
Bundling Alert
The 90-day global period bundles all routine postoperative visits, dressing changes, and suture removal into the payment for 28160, and unrelated E/M services during that window require modifier -24 with documentation establishing the unrelated nature of the visit. NCCI edits also bundle 28160 into both 28285 and 28293 when performed on the same toe in the same operative session, so claims submitting 28160 alongside either code without a modifier and without documentation of a distinct toe or site are a common source of denials and post-payment recoupment.
🌳 Code Tree — Surgery: Musculoskeletal System, Foot and Toes
CPT 28001-28899 Surgery: Musculoskeletal System, Foot and Toes
│
├── 28100-28118 Excision (Bone/Tumor, Foot)
│ ├── 28104 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bone
│ └── 28108 Excision of exostosis, phalanges, foot
│
├── 28120-28175 Excision (Phalanx and Joint, Toe)
│ ├── 28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy), bone, phalanx of toe
│ ├── 28126 Resection, partial or complete, phalangeal base, each toe
│ ├── 28153 Resection, condyle(s), distal end of phalanx, each toe
│ ├── ▶▶ 28160 ◀◀ Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each ← YOU ARE HERE (Global: 090)
│ ├── 28171 Radical resection of tumor; toe phalanx
│ └── 28173 Radical resection of tumor; metatarsal
│
├── 28175 Amputation, tumor, phalanx
│
└── 28280-28299 Repair, Revision, and/or Reconstruction (Toe)
├── 28285 Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy)
└── 28293 Correction, hallux valgus (bunion), with or without sesamoidectomy; resection or arthrodesis💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 3.02 (verify against current CY2026 CMS MPFS) |
| Global Period | 090 (90 days) |
| Bilateral Indicator | 1 — subject to standard bilateral payment reduction rules (150% payment: 100% first side, 50% second side) when identical bilateral toes are treated in the same session |
| Assistant Surgeon | ✅ Payable |
| Co-Surgeon | ❌ Not typically applicable |
| Team Surgery | ❌ Not applicable |
| PC/TC Split | ❌ No — procedure code only (Indicator 0) |
| Modifier -51 Exempt | No |
| Anesthesia | Digital block, local infiltration, or MAC/general anesthesia depending on setting; anesthesia is separately billable under the 01XXX series when administered by a separate provider |
Bilateral Billing Rules
CPT 28160 carries a bilateral indicator of 1, meaning the standard Medicare bilateral payment formula applies whenever the identical procedure is performed on corresponding toes of both feet during the same operative session. Because the code descriptor already specifies “each,” however, most real-world bilateral scenarios instead involve multiple toes on the same or opposite feet, which are typically billed as separate line items with -RT/-LT and -59 or X-modifiers rather than a single line with -50. True same-toe, opposite-foot bilateral billing (e.g., both great toe proximal phalanges) should use modifier -50 on a single line, and the MAC’s preferred format for laterality-modifier versus -50 billing should be confirmed locally before submission.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Applied when the procedure is performed on a toe of the right foot; required for correct laterality tracking against the paired ICD-10-CM diagnosis code. |
| -LT | Left Side | Applied when the procedure is performed on a toe of the left foot; mirrors the -RT logic above. |
| -50 | Bilateral | Applied when the identical procedure is performed on the corresponding toe of both feet in the same session; triggers the standard bilateral payment reduction. |
| -51 | Multiple Procedures | Applied when 28160 is performed alongside other surgical procedures in the same session, appended to the lower-valued code in the multiple-procedure fee reduction sequence. |
| -59 | Distinct Procedural Service | Applied when payers bundle 28160 with 28285 or 28293 inappropriately, documenting that a distinct toe or anatomically separate site was treated. |
| -24 | Unrelated E/M During Postoperative Period | Applied to an E/M code when the patient returns within the 90-day global window for a condition unrelated to the excised toe; the unrelated nature must be explicitly documented. |
| -58 | Staged or Related Procedure | Applied when a planned staged procedure at the same or an adjacent site is performed during the 90-day global window, such as a subsequent bone graft or joint stabilization. |
| -78 | Unplanned Return to Operating/Procedure Room | Applied when an unplanned return to the OR is required during the global period for a complication of the original excision, such as recurrent infection. |
| -79 | Unrelated Procedure During Postoperative Period | Applied when an unrelated procedure is performed on a different toe or anatomic site during the 90-day global window following the original 28160 procedure. |
🩺 Common ICD-10-CM Pairings
Primary Diagnosis Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| M20.41 | Hammer toe(s) (acquired), right foot | ❌ No | Supports 28160 when interphalangeal joint excision is performed as part of correcting a rigid, non-reducible hammertoe deformity at the right foot; confirm laterality and specific toe in the operative note. |
| M20.42 | Hammer toe(s) (acquired), left foot | ❌ No | Mirrors M20.41 for left-sided procedures; laterality must match the modifier appended to 28160. |
| M86.171 | Other acute osteomyelitis, right foot | ❌ No | Drives medical necessity when the excision is performed to eradicate infected bone; supporting imaging or culture documentation strengthens the claim. |
| M86.172 | Other acute osteomyelitis, left foot | ❌ No | Mirrors M86.171 for left-sided infections. |
Secondary Group
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| E11.621 | Type 2 diabetes mellitus with foot ulcer | ✅ HCC 38 (flag for CMS-HCC V28 verification) | Frequently reported as a secondary diagnosis when the toe excision is performed in the setting of a diabetic foot ulcer with underlying osteomyelitis; RAF impact should be confirmed against the current CMS-HCC model. |
| L97.521 | Non-pressure chronic ulcer of other part of right foot with fat layer exposed | ❌ No | Reported alongside E11.621 when a chronic ulcer overlying the excised bone is documented; laterality and depth (fat layer, muscle, bone) must be specified per ICD-10-CM combination coding rules for diabetic ulcers. |
Etiology / Complication
| ICD-10 | Description | HCC? | Notes |
|---|---|---|---|
| T81.4XXA | Infection following a procedure, initial encounter | ❌ No | Reported when a postoperative infection develops after the excision itself, distinct from a preexisting osteomyelitis that prompted the original surgery. |
| M86.9 | Osteomyelitis, unspecified | ❌ No | Used only when the infecting organism, site specificity, or acuity cannot be determined from documentation; a query should be initiated to obtain the more specific acute/chronic and laterality-specific code before this is finalized. |
Coding Specificity Reminder
The most frequently missed specificity element for this code family is laterality combined with the acute-versus-chronic distinction for osteomyelitis, since M86 codes require both an acuity qualifier and a laterality-specific foot designation. Providers documenting only “osteomyelitis of the toe” without specifying right or left, or without indicating acute versus chronic, should be queried before an unspecified code such as M86.9 is finalized. ICD-10-CM specificity requirements are not optional, and defaulting to unspecified codes when a more precise alternative is documentable in the chart creates unnecessary audit exposure.
🏥 MS-DRG Considerations
CPT 28160 is performed primarily in the office, outpatient hospital, or ambulatory surgical center setting, and there are no routine MS-DRG assignments associated with this procedure in isolation. An inpatient admission driven solely by an isolated hemiphalangectomy or interphalangeal joint excision of the toe would not be supported by CMS, a MAC, or a utilization review body under standard medical necessity criteria. When a patient is admitted as an inpatient for an unrelated principal diagnosis — for example, sepsis or a diabetic foot infection requiring IV antibiotics — and undergoes this excision as a secondary procedure during that same stay, an ICD-10-PCS code should still be assigned for facility completeness, but it will have negligible or no independent influence on DRG grouping, since the driving MS-DRG will typically be determined by the principal diagnosis and any more resource-intensive procedures performed concurrently.
🔧 ICD-10-PCS Equivalents
Note
Inpatient PCS coding for this procedure is uncommon, since hemiphalangectomy and interphalangeal joint excision of the toe are almost always performed in outpatient settings; when it is coded on an inpatient claim, it is typically incidental to a larger admission and will not meaningfully affect DRG assignment. The key root operation distinction is Excision (removal of only a portion of the body part) versus Resection (removal of the entire body part), and the choice between the bone-specific codes (0Q body system) and the joint-specific codes (0S body system) depends on whether the operative note describes a bony phalangeal segment being removed versus formal resection of the interphalangeal joint surfaces.
| PCS Code | Full Description | Modality |
|---|---|---|
0QBQ0ZZ | Excision of Right Toe Phalanx, Open Approach | Hemiphalangectomy — proximal bone segment excision, right |
0QBR0ZZ | Excision of Left Toe Phalanx, Open Approach | Hemiphalangectomy — proximal bone segment excision, left |
0SBX0ZZ | Excision of Right Toe Phalangeal Joint, Open Approach | Interphalangeal joint excision, right |
0SBY0ZZ | Excision of Left Toe Phalangeal Joint, Open Approach | Interphalangeal joint excision, left |
PCS Character Analysis — 0QBQ0ZZ
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical — the section covering all standard operative root operations. |
| 2 | Body System | Q | Lower Bones — includes the tarsals, metatarsals, and toe phalanges. |
| 3 | Root Operation | B | Excision — cutting out or off, without replacement, a portion of a body part; matches the “proximal end of phalanx” language in the CPT descriptor. |
| 4 | Body Part | Q | Toe Phalanx, Right — the specific bony structure excised in a right-sided hemiphalangectomy. |
| 5 | Approach | 0 | Open — a direct surgical incision is used to access the phalanx, consistent with the operative technique described for this procedure. |
| 6 | Device | Z | No Device — no implant, graft, or hardware is left in place as part of this excisional procedure. |
| 7 | Qualifier | Z | No Qualifier — no additional qualifying detail applies to this excision. |
Root Operation Comparison
- Use Excision (B) when only the proximal phalangeal segment or a defined portion of the interphalangeal joint is removed, consistent with a hemiphalangectomy that leaves the remainder of the digit intact.
- Use Resection (T) only if the entire phalanx or the entire joint structure is removed, which would more typically align with a toe amputation code such as 28820 rather than 28160.
- When bilateral toes are treated in the same operative session, assign separate PCS code lines for each side, since PCS has no modifier equivalent for bilateral procedures.
📝 Coding Examples
Example 1
Clinical Scenario: A 68-year-old male with type 2 diabetes presents to an outpatient surgical center with a chronic non-healing ulcer over the proximal interphalangeal joint of the right second toe, with imaging confirming underlying osteomyelitis of the proximal phalanx. The podiatric surgeon performs a hemiphalangectomy, excising the proximal segment of the phalanx and debriding the overlying ulcer bed. The operative note documents removal of approximately half the phalanx with confirmed clear bone margins on visual inspection. No separately identifiable E/M service is documented on the same date, as the visit was purely for the planned procedure.
| Field | Code | Rationale |
|---|---|---|
| CPT | 28160-RT | The operative note explicitly documents a hemiphalangectomy of the proximal phalanx with clear margins, supporting 28160 rather than the lesser partial-excision code 28124; -RT reflects the right second toe. |
| PDx | M86.171 | Other acute osteomyelitis, right foot, is the primary driver of medical necessity for the bone excision itself. |
Note
Example 2
Clinical Scenario: A 54-year-old female undergoes bilateral correction of painful, longstanding hammer toe deformities of both second toes in the same ambulatory surgical center session. The surgeon performs a full hammertoe correction with partial phalangectomy on the left second toe, and a more limited interphalangeal joint excision alone on the right second toe where the deformity was less severe. The right-sided procedure is documented as an isolated joint excision without any additional tendon or capsular work, while the left side clearly involved a complete hammertoe correction procedure.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 28285-LT | The left second toe procedure meets the full hammertoe correction descriptor, including phalangectomy, and is billed as the primary procedure for that side. |
| CPT 2 | 28160-RT-59 | The right second toe involved only an isolated interphalangeal joint excision without the additional elements of a full hammertoe correction, supporting separate reporting of 28160 with modifier -59 to document the distinct, less extensive procedure performed on a different toe. |
| PDx | M20.42 | Hammer toe(s), left foot, supports the primary hammertoe correction procedure. |
Warning
Reporting both 28285 and 28160 without modifier -59 and without clear documentation that they were performed on distinct toes will trigger an NCCI bundling edit, since 28160 is a component of 28285 when performed at the same site; the operative note must explicitly separate the two anatomic locations to survive audit.
Example 3
Clinical Scenario: A 61-year-old male undergoes an interphalangeal joint excision of the right great toe for chronic osteomyelitis. Four weeks into the 90-day global period, he returns with new-onset drainage and swelling at the surgical site, and imaging confirms a recurrent infection requiring an unplanned return to the operating room for repeat debridement and partial re-excision of residual infected bone.
| Field | Code | Rationale |
|---|---|---|
| CPT | 28160-RT-78 | The unplanned return to the operating room for a complication (recurrent infection) related to the original excision, occurring within the 90-day global period, requires modifier -78 rather than a fresh, unmodified procedure code. |
| PDx | M86.171 | Other acute osteomyelitis, right foot, continues to support medical necessity for the repeat excision, now representing a recurrence rather than the original infection episode. |
Global period reminder
Modifier -78 signals to the payer that this is a related, unplanned return during the original 90-day global period rather than a new, separately reimbursable initial procedure, and it typically triggers reduced reimbursement reflecting that a new global period technically does not restart under most payer policies. The operative note must clearly document that the return was necessitated by a complication of the original surgery to support -78 over an unmodified or -59-appended line.
⚠️ Common Coding Pitfalls
-
Confusing hemiphalangectomy with partial bone excision (28124): When the operative note only describes shaving, craterization, or sequestrectomy of a bony prominence without formally documenting removal of the proximal phalangeal segment or the joint itself, the claim should be coded to 28124 rather than 28160, and payers will frequently downcode ambiguous documentation on audit.
-
Missing NCCI bundling with 28285 or 28293: Billing 28160 alongside a full hammertoe or bunion correction on the same toe without modifier -59 and clear anatomic separation is one of the most common denial triggers for this code family, since NCCI treats 28160 as a bundled component of both procedures at the same site.
-
Defaulting to unspecified osteomyelitis coding: Reporting M86.9 (osteomyelitis, unspecified) when the documentation could support a more specific acute-versus-chronic, laterality-specific code such as M86.171 undermines both medical necessity support and risk-adjustment accuracy, and a provider query should be initiated whenever the chart supports greater specificity.
-
Failing to track the 90-day global window: Because this procedure carries a full 090 global period, practices that do not flag the surgical date risk inadvertently billing separately for routine postoperative visits, dressing changes, or suture removal that are already bundled into the payment, creating overpayment and recoupment exposure.
-
Incorrect bilateral billing format: Because the CPT descriptor already specifies “each,” true bilateral billing scenarios are less common than multi-toe scenarios on the same foot; coders should confirm whether -50 (true bilateral, same toe both feet) or separate -RT/-LT lines with -59 (multiple distinct toes) is the correct format before submission.
-
Omitting laterality on paired diagnosis codes: Submitting an unspecified-laterality diagnosis code when the operative note clearly documents a specific foot creates a mismatch between the procedure modifier (-RT/-LT) and the diagnosis code, which is a frequent source of claim edits and should be corrected before submission rather than left to payer-level rejection.
📎 Sources
1 AMA CPT 2026 Professional Edition · 2 CMS CY2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F) · 3 CMS NCCI Policy Manual, Chapter 4 (Musculoskeletal System), 2026 · 4 CMS RVU26 Relative Value Files (flagged for confirmation) · 5 ICD-10-CM Official Guidelines for Coding and Reporting FY2026 · 6 ICD-10-PCS Official Guidelines for Coding and Reporting FY2026 · 7 CMS-HCC Model V28 Risk Adjustment Documentation
AMA CPT 2026 Professional Edition (2026); CMS CY2026 Medicare Physician Fee Schedule Final Rule, CMS-1832-F (2026); CMS National Correct Coding Initiative Policy Manual, Chapter 4 (2026); CMS RVU26 Relative Value Files (2026) — wRVU flagged for confirmation; ICD-10-CM Official Guidelines for Coding and Reporting, FY2026; ICD-10-PCS Official Guidelines for Coding and Reporting, FY2026; CMS-HCC Risk Adjustment Model, Version 28 (2026) — HCC mapping flagged for confirmation