Podiatry Coding & Billing Alert

Question: My podiatrist performed a surgical cut over the patient’s metatarsophalangeal joint. They used clamps and coagulation techniques to manage small blood vessels in the area and freed up any necessary soft tissue structures. The podiatrist also 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. My podiatrist accessed the joint capsule and adjusted the metatarsal and cuneiform bones to the intended position. They then employed stabilizing apparatus to maintain the bones in the targeted position for fusion. My podiatrist also performed a sesamoidectomy. Lastly, they checked for bleeding and closed the incision. Which CPT^® code should I report for this procedure?

Tennessee Subscriber

Answer: You should report 28297 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method) for this procedure. According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, CEO of Healthcare Inspired LLC, in Bella Vista, Arkansas, “The documentation needs to reflect the dorsal incision and soft tissue dissection to the excision of the medial eminence, realignment of the metatarsal, and the placement of fixation across the joint. Additionally, 28297 can include the resection of excess bone from the dorsomedial, dorsal, or dorsolateral areas of the metatarsal head, and even the base of the proximal phalanx. These steps can be performed with or without any necessary soft tissue corrections, releases, or resections.”

Take note: 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 the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head (distal metaphysis) along with first metatarsal and medial cuneiform joint arthrodesis and may additionally 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 with or without related soft-tissue correction, resection, or release,” per CPT^® Assistant. “Code 28297 may also involve tendon and other soft tissue balancing and/or the removal of one or both sesamoids.”

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC