Polydactyly occurs in about 1 out of every 500 births in the United States, affecting both male and female babies equally. In most cases, it is a small piece of aberrant soft tissue adjacent to the thumb or pinky, but in some instances, there can bone and joint involvement. Knowing what to look for can help you decipher the procedural note and assign the correct code.

If the extra digit has bone involvement (not just soft tissue), CPT 26587 Reconstruction of polydactylous digit, soft tissue and bone is utilized. Check for clues in the operative note such as the use of bone cutters or a statement that bone was removed. The pathology report should also be reviewed to verify if the specimen contained bone or just soft tissue. If the excision consisted of soft tissue only, use CPT 11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions

CPT 11200 is also utilized for repair of supernumerary toes that are just soft tissue with no bone involvement. Polydactyly of the toes with bone involvement should be coded 28344 Reconstruction, toe(s); polydactyly.

The key is to review the notes and the path report to determine if the specimen contained bone or just soft tissue. While there are no specific modifiers for supernumerary digits, some payers may want to see RT or LT to track which hand or foot was repaired. Be sure to monitor any payer denials to determine if there is a modifier preference.

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