Podiatry Coding & Billing Alert

Question: Our podiatrist performed a hallux rigidus correction and a bunionectomy on a patient’s big toe. The correction did not involve using an implant. Can I code for both procedures using 28289 and 28296?

Indiana Subscriber

Answer: You cannot code for both procedures for the simple reason that the procedure described by 28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant) functions in the same way as 28296 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method).

Each procedure attempts to correct problems with the same part of the big toe: the first metatarsophalangeal joint. Both hallux rigidis and hallux vulgus conditions restrict toe movement when wear and tear on the joint creates new bone growth. In the case of hallux rigidis, the condition is the result of growth on the top of the joint, while new growth on the side of the joint results in a bunion (hallux vulgus). So while the growths are in different places on the same joint, both procedures attempt to remove that growth. So, the work described by 28296 (the osteotomy) is considered bundled into the work of 28289 (the cheilectomy and debridement).

Accordingly, “28296 is considered a component of the services of code 28289,” so “it is only appropriate to report code 28289 in this setting” per CPT® Assistant Volume 30: Issue 7 (July 2020).