Wiki Hello to all the foot & ankle coders.....I need HELP!

[kwinters]

My physician wants to do an INTERPOSITION OF THE GREAT TOE ARTHROPLASTY, dx = hallux rigidus. He said it's the same as 25447 which is for the intercarpal/carpometacarpal joint of the hand. I'm been researching and researching and honestly I can't find a code for it. We were going to use CPT 28291 but after my physician read the description, he said he's not doing that procedure & said it's the same as the one for the hand CPT 25447. Can anyone please help me with this code? I would greatly appreciate it.

TIA!

Kelly, CPC

 

[amyjph]

28291 w/ implant
28289 w/o implant

Key word hallux rigudus. Is there cheilectomy planned?
You have to check payer policies on it though depending on the implant if any and other info. It may not be covered due to they find it investigational.
Examples: https://www.uhcprovider.com/content...c/policies/comm-medical-drug/surgery-foot.pdf

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0446_coveragepositioncriteria_metatarsophalangeal_joint_replacement_of_the_hallux.pdf

https://www.aetna.com/cpb/medical/data/700_799/0708.html

Info from when this code area changed in 2017: https://www.aaos.org/aaosnow/2017/jan/managing/managing01/

 

[kwinters]

28291 w/ implant
28289 w/o implant

Key word hallux rigudus. Is there cheilectomy planned?
You have to check payer policies on it though depending on the implant if any and other info. It may not be covered due to they find it investigational.
Examples: https://www.uhcprovider.com/content...c/policies/comm-medical-drug/surgery-foot.pdf

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/mm_0446_coveragepositioncriteria_metatarsophalangeal_joint_replacement_of_the_hallux.pdf

https://www.aetna.com/cpb/medical/data/700_799/0708.html

Info from when this code area changed in 2017: https://www.aaos.org/aaosnow/2017/jan/managing/managing01/

No a cheilectomy will NOT be performed per the doctor. The patient has an HMO and when the auth dept tried obtaining authorization for cpt 28291, it got denied as "investigational." And that's when the doctor got involved and said he's not doing 28291 (when he read the description). That's why I'm stumped. I'm still leaning towards 28291/28289, but wanted other's opinions and expertise. I appreciate your feedback and assistance.

 

[amyjph]

If no implant would be 28289. But, still may not be covered depending on plan.

 

[moodymom]

If the procedure he will be performing mimics what is described in the attached CPT Assist then this would be coded to 28289. Code 28291 appears to involve the placement of an implant that's inserted into bone rather than tendon interposed in the joint space and I would lean towards an unlisted code for latter.