Wiki Akin & McBride Bunionectomies with ganglion cyst excision

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abaer01

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My provider is attempting to bill 28090 (ganglion cyst excision, foot) along with bunionectomy procedures 28298 and 28292. The excision bundles with both bunionectomy procedures, but is it appropriate to unbundle it with modifier 59? I don't believe so, but I can't seem to find anything speaking to these code pairs specifically. The cyst was excised from the dorsomedial aspect of the first metatarsophalangeal joint.

The only thing I can find regarding the question is from a 2017 AAPC article that states:

Know What’s Included
Carefully review all the codes in this range before choosing your final code for bunion correction. According to the American Medical Association’s (AMA) CPT® Assistant, all hallux valgus (bunionectomy) procedures include:

  • Removal of the bony prominence (bunion)
  • Removal of additional osteophytes
  • Arthrotomy
  • Capsulotomy
  • Tenotomy
  • Tendon releases
  • Tenolysis
  • Placement of internal fixation
  • Removal of bursal tissue
  • Articular shaving at the first metatarsophalangeal joint
I believe the excision of the cyst would fall under "Removal of additional osteophytes".

Thank you!!
 
I may be a bit late on this, but it seems like the ganglion was attached to the MTP joint. Unless it was performed through a separate incision, it would be bundled.
 
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