Wiki 28308 or 28309 when more than one osteotomy performed?

[krburke]

If a patient had two Weil osteotomies performed, would it be more appropriate to bill 28309 (1 unit) or 28308 (2 units)? We cannot find any definitive guidance on this and the 3M encoder takes you to 28309 if you indicate multiple, but to 28308x2 if you choose "other than first metatarsal" and specify 2 osteotomies.

Is it correct to bill either way, and if so, is this a payer-specific recommendation?

This is for the outpatient facility claim.

 

[CodingKing]

Trying to read through the descriptions and my plain language definitions code selection seems to be what metatarsal bones are involved.

28309 if multiple osteotomies without any involvement of the first metatarsal (the bone connected to the big toe). If there is any involvement with the first metatarsal it would be 28306 x1 and 28308 x number of metatarsals (MUE of 4)

 

[krburke]

Thanks for the reply.
There's no involvement of the first metatarsal, just 3rd & 4th, but it's still not clear to me whether to use 2 units of 28308 or one unit of 28309. This feels similar to the two different ways to capture bilateral procedures (-50 or RT/LT) which varies by payer, so I'm hoping someone on this forum has dealt with this issue specifically. Initially we had not coded the osteotomies at all, so we're re-examining this account on several different fronts, and this point is just not well-defined anywhere.

 

[MI_CODER]

I know my response is late but I thought I'd take a shot at this question since I just had this come up on a case I was working on. I believe CPT 28309 is more specifically for a pes cavus correction while CPT 28308 would be reported for each (Weil) metatarsal osteotomy (other than first) performed. Below are the CPT lay descriptions for each procedure:

CPT 28309: "The physician treats a patient with a high arch (pes cavus) by performing osteotomies (bone cuts) on the metatarsal bones of the foot. Two or more incisions are made on the dorsal surface (top) of the foot over the metatarsal bones. The incisions are carried deep to the bones. Tissue is dissected and debrided as needed. The physician makes cuts through the metatarsal bones one at a time. The bones are each manipulated in such a way that the angles are changed. The manipulation allows the high arch to be shifted to an appropriate position. Multiple fixation devices such as screws, plates, or pins are applied to hold the bones in their new positions. The incisions are irrigated and closed in layers."

CPT 28308: "A dorsomedial incision is made over the big toe and the skin and soft tissues are reflected. In many cases this procedure is performed in an effort to correct the poor alignment of the big toe. In addition to removal of the medial eminence, a cut is made through the metatarsal shaft and a portion of the bone is removed in order to correct the alignment of the bone. Wires are used to reattach the bone in its corrected alignment. Sutures are used to close the incision. Weight bearing is protected for several weeks. Report 28307 if a bone graft is used to correct the alignment of the first metatarsal shaft and attached with wire or screws. Report 28308 if the procedure is performed on other metatarsal bones.