Bunionectomy

How to Code Bunionectomy

Hello Coders!

In this article, I will explain everything about bunion and coding of bunion surgery procedures (bunionectomies) important for AAPC coding Exam 2017. Go through the article, practice CPC exam questions and post your queries in comments section at the end of article.

Bunion or Halux Valgus

What is BUNION :

Halux – great toe

Valgus – angulation of toe away from the midline

  • Bursa formed along the medial aspect of great toe.

bursa

  • Enlargement of bone or tissue around the joint at the bottom of the big toe (known as the metatarsaophalangeal joint).
  • It forms when your big toe pushes against your next toe, forcing joint of big toe to get bigger and stick out.

bunion

Causes :

  • Wearing tight, narrow shoes might cause bunions or make them worse
  • Bunions also can result of an inherited structural defect.
  • Stress on your foot or medical condition, such as arthritis.

What is Bunionectomy :

  • Surgery to excise all the parts of bunion that involves removing soft tissue, tendones and bone and may also involve reallining the toe joint.

bunionectomy

Types of Bunionectomy procedures:

  • There are different types of Bunionectomy procedures and it is very imprtant to know the type of procedure performed to select correct CPT code.
  • Some common bunion procedures includes:
  1. Austin,
  2. Reverse Austin ,
  3. Mitchell,
  4. Chevron,
  5. Kalish,
  6. youngswick,
  7. Reverdin,
  8. Reverdin-Green and
  9. Hohmann procedures,
  10. Akins procedures / phalanx osteotomy procedures.
  • The most commonly performed bunionectomy procedures are the Austin and Akin procedures.

Must Visit this site for more information : http://www.surgerybunion.com/

 

How to code for Bunionectomy procedures as per the CPT Code Books :

CPT code range – 28290-28299 (old codes valid till 2016)

CPT Code Procedure Type Description
28290 Silver Type Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy
28292 Keller, McBride or Mayo type Correction, hallux valgus (bunion), with or without sesamoidectomy
28293 Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant
28294 Joplin Type Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon transplants (eg, Joplin type procedure)
28296 Mitchell, Chevron or Concentric type Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy
28297 Lapidus Type Correction, hallux valgus (bunion), with or without sesamoidectomy;
28298 Phalanx Osteotomy Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy
28299 Double Osteotomy Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy

New Revised CPT Codes for Bunionectomy for 2017

Deleted Codes – 28290, 28293 & 28294 (Effective from Dec 31st  2016 )

New Revised Codes – 28289, 28292, 28296, 28297, 28298 & 28299 ( Effective from Jan 1, 2017)

CPT Code

CPT 2016

CPT 2017

Changes

28290 Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver type procedure) Deleted
28292 Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride, or Mayo type procedure Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method changed “(bunion)” to “(bunionectomy)”; and “or without” and “Keller, McBride, or Mayo type procedure” was removed; and “with resection of proximal phalanx base, when performed, any method” was added to the 2017 description.
28293 Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant Deleted
28294 Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon transplants (eg, Joplin type procedure) Deleted
28295 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method New code
28296 Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures) Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method changed “(bunion)” to “(bunionectomy)”; and “or without” and “with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)” was removed; and “when performed; with distal metatarsal osteotomy, any method” was added to the 2017 description.
28297 Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus-type procedure Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method “(bunion)” changed to “(bunionectomy)” and                                                 “or without” and “Lapidus-type procedure” was removed; and “when performed; with first metatarsal” and “medial cuneiform joint arthrodesis, any method” was added to the 2017 description.
28298 Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx osteotomy Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method changed “(bunion) to (bunionectomy)”; and “or without” and “by phalanx osteotomy” was removed; and “when performed; with proximal phalanx osteotomy, any method” was added to the 2017 description.
28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method changed “(bunion)” to “(bunionectomy)” and changed “by double osteotomy” to “when performed; with double osteotomy, any method” and “or without” was removed from the 2017 description.

 

IMPORTANT NOTE-

  • 28110 – Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)

 

Short Summary to use correct CPT – Read carefully what portion is removed with correction of Hallux Vagus (Bunnion) and select appropriate code as mentioned below:

Correction, hallux valgus (bunion), with or without sesamoidectomy;

  • 28292 – with resection of proximal phalanx base (Keller, McBride, or Mayo type procedure)
  • 28295 – with proximal metatarsal osteotomy
  • 28296 – with distal metatarsal osteotomy (Mitchell, Chevron, or concentric type procedures)
  • 28298 – with proximal phalanx osteotomy
  • 28299 – with double osteotomy 

Remember: In case of Bilateral Procedure append modifier “50”

28292 – Keller, McBride, or Mayo type procedure

Distal soft tissue release

  • Diagnosis: Hallux Valgus with Metatarsus Primus Varus
  • Procedure: Modified McBride and metatarsal osteotomy
  • Report CPT code 28292 for the McBride soft tissue procedure
  • Report CPT code 28306 for a “proximal” metatarsal osteotomy to correct the primus varus.

• Keller – resection base of the proximal phalanx
• Mayo – resection head of the first metatarsal

28296 – with metatarsal osteotomy, (Austin)

I found this video on youtube. Watch this for better understanding.

28298 – Akin Osteotomy

28298 – a phalanx osteotomy, involves removal of a bony wedge from the base of the proximal phalanx, (Akin)

28299 – Double Osteotomy

28299 – (double osteotomy) – treatment method involving combined   techniques to achieve 2 separate and distinct osteotomies.

 

28110 TAILOR’S BUNION (bunionette)

  • 28110– Ostectomy, partial excision of the 5th metatarsal head (bunionette) (separate procedure)

Example Questions for the CPC Exam

Question:
• What CPT code(s) should be reported for a hallux valgus repair performed
using a modified McBride bunionectomy technique and a Ludloff
osteotomy
?
Answer:
• Code 28292 McBride and code 28306 for the osteotomy because the
Ludloff osteotomy is primarily a metatarsal mid-shaft to base osteotomy and
code 28292 does not include proximal first metatarsal osteotomy
• Code 28296 describes a bunion repair with a distal metatarsal osteotomy,
therefore, it is not appropriate to report code 28296 for a bunionectomy with
a proximal metatarsal osteotomy

Referance guide

  • http://www2.aaos.org/bulletin/aug02/cod.htm
  • https://newsletters.ahima.org/
  • http://www.podiatrytoday.com/key-pearls-on-coding-for-bunionectomies
  • https://www.capebilling.com/news/podiatry-code-changes-for-2017

 

So that is all for now. Ask me in comments if anything is not clear. All the best for your AAPC Exam preparation.

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