Podiatry Coding & Billing Alert

Question: I’m coding an Austin-Akin bunionectomy of the big toe of the right foot and I’m a little confused about which code and modifier to use. Should I use the Austin procedure code 28296 and the Akin procedure code 28298? Also, would I use a “T” modifier since it’s correcting the misalignment of the big toe, or does it involve the metatarsal also? Would I use another modifier if it involves the metatarsals?

Kentucky Participant

Answer: In 2017, CPT^® removed the eponyms Akin and Austin from the bunionectomy codes, allowing coders to use the true description of the procedures performed. Consequently, you shouldn’t rely on those terms when coding; stick to the anatomy such as “metatarsal” and procedure terminology such as “distal” and/or “proximal.”

To answer your first question, you would use 28296 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method) for what was formerly known as an Austin procedure and 28298 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method) for the previously named Akin procedure. But you would only do this when the pair are not performed together, as they are two separate procedures.

If you use both 28296 and 28298 for an “Austin-Akin” procedure, that’s considered billing for two procedures when only one occurred, or “double dipping.” In this situation, while your podiatrist repaired two areas of bone, the podiatrist actually only performed one procedure, which is correctly coded as 28299 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method) in order to classify it as a single procedure and prevent denials.

As for your modifier question, it’s easy to inadvertently select the wrong modifier for these procedures as there are so many anatomic terms involved. Choosing modifiers for a podiatry procedure starts with an understanding of the anatomy of the foot — specifically the tarsals, metatarsals, and phalanges — to ensure proper coding.

Anatomy modifier refresher: The ankle and heel bones are the tarsals, the toes are phalanges, and metatarsals in between articulate with the tarsals and phalanges. “T” modifiers can only be used for toes or phalanx.

The descriptors for 28296, 28298, and 28299 do not indicate the exact location without modifiers, and while both procedures involve the metatarsals, they focus on the phalanx for the correction. So, you would choose the appropriate “T” modifier, which would be T5 (Right foot, great toe) for the right big toe.

Putting it all together: The code for this scenario would be 28299–T5.