Changes in Bunionectomy Coding for 2017.
Let?s look at how bunionectomy coding has changed for 2017.
- 28291 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant
CPT(R) code 28291 was added to report hallux rigidus (bunion) correction with implant; and revised code 28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant, which describes the correction of arthritis and deformity of the joint where the head of the metatarsal bone attaches to the first bone of the greater toe, now specifies the procedure was done without an implant. Prior to 2017, code 28293 reported placement of an implant for correction of hallux valgus. Because a prosthetic implant is placed for arthritis of a joint, the descriptor for 28289 is more consistent with the condition being treated (in this instance, ?implant? does not mean a screw, or plate and screw, but a prosthetic implant).
- 28295 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method
CPT(R) code 28295 describes bunion correction when a proximal metatarsal osteotomy is necessary and includes sesamoidectomy, when performed. An osteotomy may be performed when there is moderate metatarsus primus varus (deviation of the first metatarsal away from the other metatarsals) and the intermetatarsal angle is greater than 40 degrees. The osteotomy is performed at the base of metatarsal or, for a long continuous osteotomy, it may start in the metatarsal neck and extend through the shaft to the base of the metatarsal.
CPT(R) codes 28292-28299 were revised and 28290, 28293, and 28294 were deleted to remove legacy-named procedures such as Keller, McBride, Mayo, Mitchell, Chevron, and concentric- and Lapidus-type procedures. All of the new and revised bunionectomy codes now read ?sesamoidectomy, when performed,? instead of ?with or without.? Instead of using the legacy names, the procedures are defined as ?any method,? making it more clear that the coding is based on the location on the bone, as well as whether the correction was done using an osteotomy or fusion.
- 28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method
CPT(R) code 28292 describes the correction of a hallux valgus deformity, and includes sesamoid bone removal or a proximal phalanx base resection, when necessary. The sesamoid bone removal, or removal of part of the articulating end of the bone (closest to where it attaches), realigns the toe with the metatarsal at the metatarsophalangeal joint. This is generally done for mild deformities where there is very little deviation of the metatarsal. CPT(R) instructs us to also use the code for simple exostectomy, previously reported with 28290.
- 28296 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method
CPT(R) code 28296 was revised to add the word ?distal,? which describes the location of the metatarsal osteotomy. Report 28296 to correct a hallux valgus deformity with a distal metatarsal osteotomy. The procedure may also include sesamoid bone removal, when necessary, to help with bone realignment. This type of correction is done for patients with mild hallux valgus of less than 40 degrees and a minimal increase in the deviation of the metatarsal.
- 28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method
CPT(R) code 28297 reports a bunion correction with a joint fusion between the foot bone located behind the big toe (first metatarsal) and the bone of the middle foot located behind the first metatarsal. The fusion may be done with sesamoid bone removal, when necessary. This type of correction is done for a severe intermetatarsal angle or instability of the first tarsometatarsal joint.
- 28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method
CPT(R) code 28298 reports a bunion correction that includes a proximal phalanx osteotomy where bone is removed at the base of the big toe to help straighten it. This procedure may be performed with sesamoid bone removal, when necessary, to help with bone realignment.
- 28299 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method
CPT(R) code 28299 reports a bunion correction where two osteotomy procedures are done to straighten the toe and the metatarsal. These procedures may be done along with sesamoid bone removal, when necessary, to help with realignment. The double osteotomy can be a combination of an osteotomy of the phalanx and the metatarsal (proximal or distal) or a proximal and distal metatarsal osteotomy.
Carefully review all the codes in this range before choosing your final code for bunion correction. According to the American Medical Association?s (AMA) CPT(R) Assistant, all hallux valgus (bunionectomy) procedures include:
- Removal of the bony prominence (bunion)
- Removal of additional osteophytes
- Arthrotomy
- Capsulotomy
- Tenotomy
- Tendon releases
- Tenolysis
- Placement of internal fixation
- Removal of bursal tissue
The majority of bunionectomy procedures are performed to correct the deviation of the metatarsal. When correcting that deformity, the valgus deformity of the toe often corrects without the need for additional surgery, such as an osteotomy of the phalanx.
