Podiatry Coding & Billing Alert

Hint: Code 28292 does not include an osteotomy.

When your podiatrist performs a bunionectomy, you have numerous CPT^® codes to choose from. You must look at the documentation closely for the details that will point you to the appropriate code for your specific case. For example, you must know if your podiatrist performed an osteotomy or not. Take a look at bunionectomy codes 28292, 28295, and 28296.

Stayed tuned next month to learn about the rest of the bunionectomy codes.

Step 1: First, Define Bunions for Clarity

A bunion is defined as inflamed swelling of the small fluid-filled sac on the first joint of the big toe accompanied by enlargement and protrusion of the joint.

“In truth, a bunion is a foot deformity,” explains Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. “Usually, the big toe bone curves instead of being straight. This can cause the bone to jut out of the side of the foot. While the technical term for a bunion is hallux valgus, not all bunions are the same. There are different conditions such as hallux rigidus and hallux limitus, to name a few. When billing for a bunion, make sure to use the most specific diagnosis code available for your procedure.”

Why do bunions form? A bunion may form due to both intrinsic and extrinsic factors, per CPT^® Assistant Volume 26, Issue 12.

Intrinsic refers to the natural makeup of the patient’s feet. Intrinsic factors that can lead to the development of a bunion include genetics, hypermobility of the first ray, instability/ weakness in the muscles and tendons that control the first ray, and structural deformities.

Extrinsic (outside) causes of bunions include when the patient wears improper fitting shoes; certain activities such as prolonged walking or standing, and running, or dancing; and a direct injury.

Step 2: Delve Into 28292’s Requirements

Code 28292 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method) is one of the choices you can report when your podiatrist performs a bunionectomy.

“When coding for bunions, analyze the documentation provided,” Jordan says. “The operative report may reference legacy-named procedures such as Keller, McBride, or Mayo. All of these procedures are covered by code 28292. Also, when a base resection is done to the proximal phalanx, your documentation will most likely include the placement of a Kirchner wire to hold the joint.”

The work for 28292 includes when your podiatrist removes prominent or hypertrophied bone from the medial aspect of the patient’s first metatarsal head, per CPT^® Assistant. This code may also include when your podiatrist resects excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head and/or base of the proximal phalanx.

Additionally, for a 28292 service, your podiatrist may perform tendon and other soft tissue balancing and a transverse resection of the proximal phalanx base. Your podiatrist may also remove either one or both sesamoids.

However, the work for code 28292 does not include any osteotomy or fusion procedures, according to CPT^® Assistant.

Osteotomy defined: An osteotomy is a procedure where the surgeon cuts the big toe joint and realigns it to a normal position, according to Jordan. Osteotomies are done to correct a deformity and may be performed in various places along the bone. Additionally, there are times where your surgeon may remove a small wedge of bone to allow the toe to straighten.

Step 3: Pinpoint What 28295 Involves

Code 28295 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method) is another option you have when your podiatrist performs a bunionectomy. Your podiatrist will normally perform a 28295 service to correct a “moderate-to-severe hallux abductovalgus deformity with an associated high intermetatarsal angle,” per CPT^® Assistant.

The work for 28295 includes the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head. However, unlike 28292, code 28295 does include a proximal first metatarsal osteotomy.

Code 28295 may also include the resection of excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head; and/or base of the proximal phalanx.

When your podiatrist performs a 28295 service, they may perform tendon and other soft tissue balancing. Additionally, they can remove one or both of the sesamoids.

Step 4: Discover Most Common Bunionectomy Code

Code 28296 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method) is another option you have for a bunionectomy. In fact, this is the most commonly performed bunionectomy procedure.

“Although code 28296 is the most common bunion procedure performed, there are insurance plans that require a prior authorization,” Jordan says. “Be prepared to provide all conservative care that was done prior to making the decision for surgery. This can include injections, physical therapy, and strappings. The insurance company may request copies of the chart notes, X-rays, and any records from the patient’s family physician. Providing the requested items will confirm that the surgery is medically necessary and reduce the possibility for denials.”

Code 28296 includes the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head. This code includes a distal first metatarsal osteotomy. Additionally, your podiatrist may perform a resection of excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head; and/or base of the proximal phalanx, according to CPT^® Assistant.

Code 28296 includes tendon and other soft tissue balancing, as well as the removal of one or both sesamoids.

Podiatrists usually perform a 28296 service “to correct a mild-to-moderate hallux abductovalgus deformity associated with a mild-to-moderate intermetatarsal angle (metatarsus primus varus [adductus]) and/or distal lateral torsional deviation of the metatarsal head,” CPT^® Assistant explains.