Wiki CPT 28292/28298

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Heatherc7

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Hi there,

I'm new to DPM specialty and my provider likes to bill CPT 28292 (Dx M21.612) modified McBride and CPT 28298 Akin procedure (M20.12) during the same visit. Is this unbundling? Insurance companies, seem to like to bundle the CPT 28292, even with a modifier -59 (claims not submitted by me.)

I greatly appreciate any guidance!
 
Thank you for the link to the forums. The information I found didn't specially address the two codes 28292 & 28298 billed together in the same visit. I can't find any reference to them being coded together. Maybe that should tell me something. Still looking for some insight :)
 
You would have to either convert the combo to 28299. It sounds crazy because it says double osteotomy in the description but it's essentially a combination of 2 bunion procedures = 28299. Trying to unbundle the two with a 59 incorrectly is why it's being denied. Or, the other option is report only 28298.
Specifically this:
This is an old link but the concepts are still the same. Just keep in mind the CPT codes for bunions changed in 2017 so the code descriptions are not exactly the same.
http://www2.aaos.org/bulletin/aug02/cod.htm
"28299 - ; by double osteotomy There are two techniques described in the CPT book. One includes a proximal and distal osteotomy of the first metatarsal. The other example includes a distal osteotomy of the first metatarsal plus a base osteotomy of the attached proximal phalanx. AAOS states that this procedure includes: any combination of hallux valgus procedures (e.g. 28290-28298, 28485), includes all osteotomies of the first metatarsal and first proximal phalanx and allows additional coding and report for ankle tendon lengthening."

I have seen other debates and opinions on this that this combo type should be reported with 28298 only. See here: https://www.tldsystems.com/bunion-confusion#:~:text=As far as the procedure,bill is CPT code 28298.

You can also check CPT Assistant, which I have no access to at the moment.
 
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