Wiki Does the approach affect the CPT for both bunionectomy and hemiphalangectomy? Provider wants 28899 x2

[SarahSee1114]

I'm auditing a chart where provider wants to use 28899 for both bunionectomy done via medial longitudinal incision and also the same second line 28899 for for hammertoe correction doe via inter-digital approach. Is the approach enough to go with an unlisted code for these procedures? "Attention was directed to medial aspect of the 1st metatarsal head where a curvilinear longitudinal incision was made medial to the 1st MPJ joint...with distal osteotomy" And for the hammertoe, "On the 4th digit attention was directed inter-digitally to the PIPJ where inter-digital incision were made laterally..." I see no other differences in the procedures other than the approach. I would like to use 28296 for the bunionectomy due to the phrase "any method." And open to 28285 for hammertoe with hemiphalangectomy unless there is reason to consider the approach. I would appreciate anyone's insight or thoughts. Thanks!

 

[amyjph]

I would have to see the note, but if there is a CPT already established which describes the procedure (or specifically states approach like spine approaches anterior/posterior, etc.) this would not cause an unlisted code. If the bunion was corrected via distal metatarsal osteotomy and meets the description of 28296 you can't report an unlisted. Same goes for the hammertoe, hammertoe correction (fusion, phalangectomy) is 28285. You are correct, the words "any method" for the 28296.

Is this a scenario where you have a relationship with the provider to understand why they (if they picked it) chose the unlisted codes? Educational opportunity. Also, only one unlisted CPT can be reported per anatomic area so it would be weird to have two of these on one claim even if you could. Unlisted codes take longer to get paid and always cause headaches so not sure why a provider would voluntarily pick those.