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PLAIDMAN

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My doc is doing simple resection of medial eminence 28290 (sometimes 28292) for hallux valgus deformity ...he is also doing 1st metatarsal cuneiform joint fusion 28740 as separate procedure with dx of oseoarthritis of met/cuneif joint.

I dont show these as being included with each other in the NCCI edits. Would I only use 28297 if they were being done for same dx ?

I think I may be confusing myself?

Any advice would be appreciated.
 
The 28297 looks like it would include both - the lay description reads that it includes the arthrodesis and 'possible removal of the sesamoids' ... I know you asked about the medial eminence - the cpt book shows arthrodesis and the medial eminence being removed. It looks/sounds like it includes both.
 
This is what is confusing me.

Why would a coder pick 28297 over the 28290 + 28740 ?

Is there some rule I have missed saying 28297 trumps what the doc is saying?

He is coding 28290 w/ dx 735.0 and 28740 w/ dx 715.37, I dont see any problem coding this? Am I wrong ? If so why, where can I find documentation stating I would have to code a 28297?

thanks again
 
Well, you know what they say about 'most appropriate code' - if there's a code that includes both, then that is the most appropriate, vs 2 separate codes. It's frustrating sometimes with podiatry because the CCI edits don't often 'work,' if that makes any sense.

Here's something from online 'Podiatry Today' Vol 23, Issue 2, Feb 2010
"Key Pearls on Coding for Bunionectomies"
CPT 28297. This code describes the Lapidus type bunionectomy, which involves fusion at the first metatarsocuneiform joint. This procedure code also covers soft tissue joint work at the first metatarsophalangeal joint, including resection of the medial eminence.

Does that help?
 
There is only one official, recognized listing of CPT codes and it is the CPT Professional Book. Pages 198-199 of the 2021 CPT Professional Book describe CPT 28297 as including removal of the medial eminence of the first metatarsal head and arthrodesis of the first metatarsocuneiform joint. The figure on page 199 of the 2021 CPT Professional Book demonstrates that removal of the medial eminence of the first metatarsal head and arthrodesis of the first metatarsocuneiform are both included in CPT 28297.

Hence 28297 would be the correct code
 
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