Health Information Management

Q&A: What procedure code should coders report for a reconstruction polydactyly?

JustCoding News: Inpatient, July 7, 2010

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QUESTION: What is the correct ICD-9-CM procedure code to report a reconstruction polydactyly? The CPT code is 28344, but I'm not sure whether ICD-9-CM procedure code 86.26 is the correct code?

ANSWER: Procedure code 86.26 (ligation of dermal appendage) is also used for the ligation of supernumerary toe. The term polydactyly indicates that the patient has more than five fingers or toes, and the term supernumerary means having more than the normal number.

However, according to Stedman’s Medical Dictionary, ligation means “the application of a ligature—a thread, wire, fillet, or the like, tied tightly around a blood vessel, the pedicle of a tumor, or other structure to constrict it.”

Procedurally, this does not appear to match what you describe as reconstruction. The most common treatment for polydactyly is disarticulation, as is determined by the duplicated bony parts as well as the configuration of the metatarsal. Disarticulation involves reconstructive techniques to sever the bone, muscle, and skin, and close them off in a proper fashion.

I am concerned that ICD-9-CM procedure code 86.26 does not properly represent the level of work the physician performed, so I would suggest reporting ICD-9-CM procedure code 84.11 (disarticulation of toe).

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at

This answer was provided based on limited information submitted to Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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