Podiatry Coding & Billing Alert

Code 28299 has 3 different double osteotomy options.

Last month, you learned all about three common bunionectomy codes 28292, 28295, and 28296 in the article “Follow 4 Handy Steps to Perfect Your Bunionectomy Claims.” In this issue, we will take a look at the last three bunionectomy codes — 28297-28299.

Read on to keep your bunionectomy coding in tip-top shape.

Understand What Bunions Are

A lot of times a bunion starts due to an instability of the first tarsometatarsal (TMT) joint. It the first metatarsal and the medial cuneiform, explains James Werling, PT, DPT, MTC, CFC, IDN cert, physical therapist and owner of Pro Motion Physical Therapy in Raleigh, North Carolina. The first metatarsal will internally rotate and the medial sesamoid bone at the toe will be more exposed. This is the bulge you see at the joint. When the first metatarsal rotates, it causes the metatarsophalangeal (MTP) joint to have a dysfunction where the phalanx will move into a genu valgus or laterally. That is when you see the big toe cross over the second toe and is usually why the joint is painful.

“If treated early, the instability can be corrected through manual work and stability exercises for the foot,” Werling says. “But if it is not addressed for a long time and the condition is more chronic, then surgery is a good option. There are great outcomes of bunion surgery, and after proper physical therapy, patients are expected to have a full recovery.”

Observe 28297 Coding Example

Code 28297 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method) is one of the choices you have when your podiatrist performs a bunionectomy.

Take a look at this coding example: The podiatrist made an incision over the patient’s metatarsophalangeal (MTP) joint. They clamped and coagulated small vessels along the path and released soft tissue structures as needed. The podiatrist removed the enlarged bump of bone on the side of the foot. They then used a separate incision to access the joint between the first metatarsal and medial cuneiform. The podiatrist entered the joint capsule and aligned the metatarsal and cuneiform bones to be in the target position. They used fixation devices to hold the bones in the desired fused position. The podiatrist also performed a sesamoidectomy. Lastly, they checked for bleeding and closed the incision.

You should report code 28297 on your claim.

Code 28297 can be confusing to new coders, says Jeri L Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. Two separate codes make up code 28297 — 28292 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method) and 28740 (Arthrodesis, midtarsal or tarsometatarsal, single joint). Therefore, a coder may ask, “Why can’t I code both surgeries, since they will pay better?” The answer to this question is that you are required to use the most appropriate code. Since a code encompasses both procedures, code 28297, this is the correct code to use.

Don’t miss: Your podiatrist will perform a 28297 procedure “to correct a hallux abductovalgus deformity with associated long first metatarsal, hypermobile first ray or instability in the first metatarsocuneiform joint, high medially deviated first metatarsocuneiform angle, arthritic changes in the first metatarsocuneiform joint, and/or failed first ray osteotomy,” according to CPT^® Assistant Volume 26, Number 11.

Code 28297 includes several specific services such as the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head, along with first metatarsal and medial cuneiform joint arthrodesis. 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 with or without related soft-tissue correction, resection, or release.

Your podiatrist may also perform tendon and other soft-tissue balancing and/or the removal of one or both sesamoids during a 28297 service.

See What 28298 Service Entails

You may also turn to code 28298 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method) when your podiatrist performs a bunionectomy.

Your podiatrist will normally perform a 28298 service when a patient has a mild-to-moderate hallux abductovalgus deformity that is typically associated with a high hallux abductus interphalangeal angle.

“Pay special attention to the operative reporting when choosing a bunionectomy that includes a phalanx osteotomy,” cautions Jordan. “Be sure to discern if the procedure was performed on the proximal or the distal phalanx — or both. If the documentation does not specify where it was done, you will need to investigate further. Work with your surgeon to provide clear documentation. This will prove valuable should the payer request notes for your claim or perform an audit in the future.”

A 28298 service includes when your podiatrist removes prominent or hypertrophied bone from the medial aspect of the first metatarsal head, along with a proximal phalanx osteotomy to correct the bone position, according to CPT^® Assistant. Code 28298 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 with or without related soft-tissue correction, resection, or release.

Additionally, your podiatrist may perform tendon and other soft-tissue balancing and/or the removal of one or both sesamoids with a 28298 service, which is included in the work for this code.

Code 28299 Includes Double Osteotomy

When your podiatrist performs a bunionectomy with a double osteotomy, code 28299 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method) may be the right option.

Your podiatrist will perform a 28299 service when a patient has a severe hallux abductovalgus deformity with associated multilevel first ray deformities, including a mild to high intermetatarsal angle, with or without a high hallux abductus interphalangeal angle, per CPT^® Assistant.