Orthopedic Coding Alert

Question: Encounter notes indicate that a patient reports to the surgeon with a bunion on their right great toe. The provider removes bone from the bunion, and also removes the sesamoid bones under the great toe. Can I code the sesamoidectomy separately from the bunionectomy?

AAPC Forum Subscriber

Answer: No, you cannot report the sesamoidectomy separately. It is bundled into the bunionectomy code. On the claim, report:

• 28292 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method) for the bunionectomy
• Modifier RT (Right side) appended to 28292 to indicate laterality
• M21.611 (Bunion of right foot) appended to 28292 to represent the patient’s bunion

Other bunionectomy codes: There are several types of bunionectomy, and each code includes another surgical procedure (such as osteotomy). Here’s a look at the other bunionectomy codes:

• 28296 (… with distal metatarsal osteotomy, any method)
• 28295 (… with proximal metatarsal osteotomy, any method)
• 28297 (… with first metatarsal and medial cuneiform joint arthrodesis, any method)
• 28298 (… with proximal phalanx osteotomy, any method)
• 28299 (… with double osteotomy, any method).

Best bet: When you see bunionectomy along with another service on a claim, make sure the services aren’t both covered in one of the bunionectomy codes.