“I have a patient who had a chevron bunionectomy 10 years ago. The bunion has returned and the head is facing lateral. My plan is to perform a Lapidus procedure to reduce the first intermetatarsal angle and a rotational 1st metatarsal head osteotomy to align the articular surface (basically an Austin with a medial based wedge removed from the dorsal osteotomy to rotate the head slightly medial). How would you recommend I code this (ICD-10 and CPT codes)? Can I use CPT 29297 and CPT 29296? I’ve also considered CPT 28740 with CPT 29296. Thanks.”
So, it is a case of the return of the dreaded hallux valgus deformity. It took 10 years for it to reoccur with pain. It appears that a 1st metatarsal-medial cuneiform arthrodesis was performed to reduce the IM angle and a distal 1st metatarsal osteotomy to rotate the 1st metatarsal head medially. How should this be coded?
Option #1: Coding CPT codes 28297 and 28296.
CPT code 28297 is defined as the following: Correction, hallux valgus with bunionectomy, with sesamoidectomy, when performed, with 1st met med cuneiform joint arthrodesis, any method.
CPT code 28296 is defined as the following: Correction hallux valgus with bunionectomy, with sesamoidectomy, when performed, with distal metatarsal osteotomy, any method.
At face value this appears to be a good coding scenario for what was performed in the above post. However, there are 2 issues:
1. Both CPT codes require a bunionectomy to be performed. In other words, for either of these CPT codes to be billed, the medial aspect of the head of the 1st metatarsal needs to be resected. Afterall, hallux valgus correction procedures usually include a bunionectomy. Since it can only be performed once, both of these two CPT codes cannot be billed together.
2. There is no mention in the above post that the medial aspect of the head of the 1st metatarsal was resected. Therefore, a bunionectomy was not performed, negating the billing of either of these 2 CPT codes.
Option #2: Coding CPT codes 28740 and 28296.
CPT code 28740 is defined as the following: Arthrodesis; midtarsal or tarsometatarsal, single joint.
CPT code 28296 is defined as the following: Correction hallux valgus with bunionectomy, with sesamoidectomy, when performed, with distal metatarsal osteotomy, any method.
If the medial aspect of the head of the 1st metatarsal was resected aka bunionectomy, this would be the most appropriate way to code the procedures that were performed in the above post. The coding scenario would be:
28296 – RT/LT
28740 – 59, RT/LT
The ICD-10-CM code for both procedures would be M20.11 or M20.12. Hallux valgus, right foot or Hallux valgus, left foot respectively.
Since the medial aspect of the head of the 1st metatarsal was not resected, this procedure code set is not billable.
Option #3: If the medial aspect of the head of the 1st metatarsal was not resected, the following 2 CPT codes would need to be coded: 28306, 28740.
CPT code 28306 is defined as the following: Osteotomy, with or without lengthening, shortening or angular correction, metatarsal first metatarsal.
CPT code 28740 is defined as the following: Arthrodesis; midtarsal or tarsometatarsal, single joint.
When the NCCI edits are accessed, CPT code 28740 is the Column 1 code to CPT code 28306 the Column 2 code and therefore CPT code 28306 is not separately reimbursable. However, since CPT code 28306 was performed at the distal aspect of the first metatarsal and CPT code 28740 was performed at the proximal aspect of the 1st metatarsal they would be classified as Distinct Procedural Services justifying the appending of the 59 modifier to CPT code 28306. The coding scenario would be the following:
28740 – RT/LT (ICD-10-CM code: M20.11 or M20.12 - Hallux valgus, right foot or Hallux valgus, left foot respectively).
28306 – 59, RT/LT (ICD-10-CM code: M21.6X1 or M21.6X2– Other acquired deformities of right foot or Other acquired deformities of left foot, respectively).
This is my opinion.
Michael G. Warshaw, DPM, CPC
Senior Consultant for Pulsewise
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