Key Pearls On Coding For Bunionectomies

Author(s): 
Anthony Poggio, DPM

Given the common nature of bunionectomies, this author offers pertinent insights on coding for bunionectomies that involve the first metatarsal as well as coding for combination procedures.

   Bunion surgery can be difficult to code as there are many variations to each procedure. The key to billing the bunionectomy is to focus on the inherent procedure as opposed to one’s personal preference in regard to variations to the procedures, the use of specific fixation devices/material or even additional services.

   With this in mind, let us consider a few general points.

   In regard to fixation of a first metatarsal osteotomy, there is no variation in reimbursement if you are using a K-wire, screw, plate or other fixation devices. Payment is always based upon the inherent procedure you have performed and the standard of care. I have seen physicians attempt to bill the use of an external fixation device with certain bunion procedures. However, the fixation unit and the extra work involved would not be payable as that is more of a doctor preference of fixation choices and not necessarily the standard of care.

   Utilizing other types of materials to reinforce tendons or capsules may or may not be covered if this is not a common practice in performing the given bunionectomy procedure. Certain insurance carriers may have specific guidelines for the use of these materials.

   In regard to other “newer” devices/materials, such as those used to bind metatarsals together to decrease the intermetatarsal angles, these products are generally not covered by insurance companies. The rationale is that the use of these products is perceived as more of a personal preference of the physician and may be unproven in the literature.

   Keep in mind that “tendon transfers” involve an actual transfer re-routing of the tendon and not just simply reattaching a tendon a few millimeters to one side. These corrections generally occur at the joint level and work at the joint is considered part of the overall bunionectomy procedure. Keep in mind that the commonly billed tendon transfer code CPT 27690 is listed in the leg portion of the CPT book and not the foot section. Hence one should not use this code for forefoot “tendon transfers.”

   Since no bunionectomy would necessarily qualify as a standard bunionectomy, you must rely on the closest possible procedure when selecting your billing code. In the CPT book, especially in the professional edition, there are pictures included to provide an idea of how to code various bunionectomy procedures.

Mastering The Common Bunionectomy Codes

   Here are some common first metatarsal/bunionectomy CPT codes.

   CPT 28111. This code is for the complete resection of the first metatarsal head.

   CPT 28288. This code is for a partial ostectomy of a metatarsal head. There is no mention in the code descriptor as to which specific metatarsal this applies to. However, this code most commonly applies to the lesser metatarsals.

   CPT 28289. Similar in nature to CPT 28288, this code is specifically for the first metatarsal joint. This is the best code to use when one is performing a cheilectomy procedure to increase motion at the joint in order to address hallux limitus/rigidus. This procedure code also includes any capsular release the surgeon deems necessary, as well as dissection and removal of additional prominences on the base of the proximal phalanx that are jamming the joint.

   CPT 28290. This code describes a Silver-type (simple exostectomy) bunionectomy procedure. This would involve resecting the medial eminence. This code also covers releasing or excising the sesamoid.

Comments

Does anyone have any idea why the 28292(Keller type) code pays more than the 28296 (Austin type with a V osteotomy and fixation)

I found this article to be well composed and full of excellent coding information. Thank you for putting this information together. I would love to see Dr. Poggio write more articles. Thank you. Anita

Great coding tool

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