exerpt from codecorrect
Hope this helps
CCI has now bundled many procedures into BUNIONECTOMY
Chapter 4 NCCI guidelines
"13. CPT codes 28288, 28306, 28307, 28310, and 28315 should not be reported with BUNIONECTOMY CPT codes 28290-28299 for procedures performed on the ipsilateral first toe or metatarsal. CPT codes 28306, 28307, and 28310 (osteotomy procedures) should not be reported with a BUNIONECTOMY code because there are BUNIONECTOMY codes that include osteotomy of the first metatarsal or proximal phalanx of the first toe. CPT code 28288 (ostectomy . . .) should not be reported with a BUNIONECTOMY code because it is a misuse of this code to report ostectomy of the median eminence of the metatarsal bone which is integral to the BUNIONECTOMY procedure. Additionally, some BUNIONECTOMY procedures include excision of the head of the first metatarsal.
CPT code 28315 (sesamoidectomy, first toe (separate procedure)) includes the “separate procedure” designation in its code descriptor. CMS payment policy does not allow separate payment for a procedure designated as a “separate procedure” when performed along with another procedure in the same anatomic area. "
CCI also states that removal of hardware can be considered inclusive:
"7. There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable.
Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure. "
CPT states that code 20650 is a 'separate procedure' so can only be reported if done by itself OR for an unrelated situation. Pinning is considered included in the BUNIONECTOMY codes per AAOS.
Per AAOS it appears they are included:
CPT Code: 28292
Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, MCBRIDE, or Mayo type procedure
Intraoperative services included in the global service package:
1. local infiltration of medication(s), anesthetic or contrast agent before, during, or at the conclusion of the operation (eg, 11900, 11901, 15860, 20500, 20501, 76080, 90780, 90799)
2. suture removal by operating surgeon or designee (eg, 15850, 15851)
3. surgical approach, with necessary identification, isolation and protection of anatomical structures, including hemostasis and nerve stimulation, or skin scar revision
4. wound culture (eg, 87070, 87076, 87077, 87102, 87163)
5. wound irrigation
6. intraoperative photo(s) and/or video recording, excluding ionizing radiation
7. intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
8. insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), catheter(s), or suction device(s)
9. closure of wound and repair of tissues divided for initial surgical exposure, partial or complete (eg, 12001-13153)
10. application of initial dressing, wound vacuum device, orthosis, continuous passive motion, splint or cast, including traction, except where specifically excluded from global package (eg, 15852, 29000-29799)
11. preparation and insertion of synthetic bone substitutes (eg, hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix)
12. arthrotomy (eg, 28022)
13. synovial biopsy (eg, 28052)
14. tendon release or transfer (eg, 28240)
15. synovectomy (eg, 28072)
16. capsular release and reconstruction (eg, 28270)
17. removal of additional exostoses in the area of the joint (eg, 28122, 28124, 28126, 28288)
18. internal fixation (eg, 28485)
19. articular shaving
20. arthroscopy (eg, 29909)
21. removal of bursal tissue
22. repair of released tendon (eg, 28200, 28208)
23. capsular arthroplasty (eg, 28270)
24. first metatarsal head resection (eg, 28111, 28288)
25. excision of bone or synovial cysts (eg, 28090-28092, 28104, 28108)