Podiatry Coding & Billing Alert

Question:

North Carolina Subscriber

Answer:

First, you need more details on the nature of the procedure. Most likely, you can scratch 28299 (Correction, hallux valgus [bunion], with or without sesamoidectomy; by double osteotomy) because your podiatrist's procedure is not a hallux valgus correction and doesn't fit under any of CPT's hallux valgus correction codes.

A hallux valgus correction would involve an osteotomy of the first metatarsal -- not of the second and third. And a "double osteotomy," according to 28299, means that the doctor did two osteotomies on the same metatarsal, not two separate metatarsals.

Because your op note fits the description of an osteotomy that did not involve lengthening, shortening or angular correction of the metatarsals, you can safely choose between 28308 (Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each) and 28309 (... multiple [e.g., Swanson type cavus foot procedure]). Already, this discrepancy brings up the point that you should verify the reason for the surgery and accompanying diagnosis codes.

But the best answer with the evidence you have is to use 28308 twice, append modifier 59 (Distinct procedural service) on the second code and send in an op note to verify the modifier.

Reason: Most of the time, coders report the multiple osteotomy code (28309) for pes cavus procedures. You would need evidence of osteotomies on four or five metatarsals before considering 28309.