CPT® Code 28286

The procedure described by CPT® Code 28286 involves the correction of a cock-up fifth toe, which is a condition where the fifth toe is positioned in a dorsiflexed manner at the proximal interphalangeal (PIP) joint. This correction is achieved through a surgical technique known as the Ruiz-Mora procedure, which utilizes a plastic skin closure to ensure proper healing and alignment of the toe. The surgical approach begins with a dorsal incision made over the PIP joint of the fifth toe, allowing access to the underlying structures. During the procedure, an ellipse of skin is excised from below the proximal phalanx, slightly medial to the incision margin, to facilitate the correction. The flexor tendons are carefully dissected and retracted to expose the PIP joint, where the joint capsule is incised, and the collateral ligaments are released to allow for proper alignment. The head of the proximal phalanx may be excised, or in some cases, the entire proximal phalanx may be removed. If significant portions of the proximal phalanx are excised, the flexor and extensor tendons are secured together using purse-string sutures. Finally, a plastic repair of the skin is performed to maintain the toe in the correct plantar-medial direction, ensuring both functional and aesthetic outcomes for the patient.