Podiatry Coding & Billing Alert

Question: The podiatrist made an incision in the patient’s foot over the target area. He deepened the incision to reach the first metatarsal bone, and he clamped and coagulated small vessels along the path. He then made an incision through the metatarsal and removed a small wedge of bone. He realigned the bones in a more appropriate position used fixation devices to maintain that positioning. Also, during the procedure, the podiatrist performed a sesamoidectomy. Which CPT^® code should we report for this procedure?

Alabama Subscriber

Answer: You should report 28296 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method) for this procedure.

Code 28296 “includes the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head (distal metaphysis) along with distal first metatarsal osteotomy, 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, according to CPT^® Assistant Vol. 26, No. 12.

Code 28296, which CPT^® Assistant calls the “most commonly performed bunionectomy procedure,” may also include tendon and other soft-tissue balancing and/or 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.