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Find out if bunionectomies and sesamoidectomies can be coded together.

Within your podiatry practice, you no doubt come across patients dealing with the discomfort and prevalence of bunions. Numerous CPT^庐 and ICD-10-CM codes are available for documenting bunions and their various treatment methods. How familiar are you with these codes?

Take a look at the scenarios below to sharpen your skills.

Bunions defined: A bunion is essentially a foot abnormality characterized by an inflamed, swollen sac filled with fluid at the first joint of the big toe, which also exhibits enlargement and protrusion of the joint. Typically, the bone of the big toe deviates from its straight alignment, leading to a protrusion on the side of the foot. Although the medical term for a bunion is hallux valgus, bunions can vary in type and severity. Other related conditions include hallux rigidus and hallux limitus, among others.

Solve This Bunionectomy/Sesamoidectomy Combo

Scenario: The patient presented to the surgeon with a bunion on their right big toe. The surgeon performed a bunionectomy, which involved the removal of the bunion鈥檚 bone, and also excised the sesamoid bones beneath the big toe.

Solution: For this scenario, the sesamoidectomy and bunionectomy are reported together with one code as they are already bundled. On your claim, you鈥檒l report the following codes:

• 28292 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method) for the bunionectomy
• Modifier RT (Right side) appended to 28292 to indicate laterality
• M21.611 (Bunion of right foot) appended to 28292 to represent the patient鈥檚 bunion

Quick tip: If a claim includes a bunionectomy and another service, ensure that both services aren鈥檛 already incorporated within one of the bunionectomy codes.

Resolve This Hallux Rigidus Situation

Scenario: The patient underwent a procedure to correct hallux rigidus and a bunionectomy on their big toe, performed by our podiatrist. The correction process did not require the use of an implant. Are you allowed to bill for both procedures separately?

Solution: Both procedures, 28289 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant) and 28296 (Correction, hallux valgus bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method), cannot be coded simultaneously. This is because both procedures address issues with the same part of the big toe; specifically, the first metatarsophalangeal joint.

Both hallux rigidis and hallux valgus conditions limit toe movement due to new bone growth caused by joint wear and tear. Hallux rigidis is characterized by growth on top of the joint, while hallux valgus, or a bunion, is characterized by growth on the joint鈥檚 side.

Despite the growths being in different locations on the same joint, both procedures aim to eliminate this growth. Therefore, the work described by 28296 (the osteotomy) is considered included in the work of 28289 (the cheilectomy and debridement).

Make note: Accordingly, 鈥�28296 is considered a component of the services of code 28289,鈥� so 鈥渋t is only appropriate to report code 28289 in this setting,鈥� per CPT^庐 Assistant, Volume 30, Issue 7.

Bust This Bothersome Bone Bump Case

Scenario: The patient underwent a procedure performed by the podiatrist, which involved making an incision over the metatarsophalangeal joint. Small blood vessels in the area were managed using clamps and coagulation methods, and any necessary soft tissue structures were liberated. The podiatrist also excised the protruding bone bump on the side of the foot. A separate incision was made to reach the joint between the first metatarsal and medial cuneiform. The joint capsule was accessed, and the metatarsal and cuneiform bones were realigned to their desired position. Stabilizing equipment was used to keep the bones in place for fusion. A sesamoidectomy was also performed by the podiatrist. Finally, the incision was checked for any bleeding before being closed.

Solution: For this procedure, you would use code 28297 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method). The medical documentation should detail the dorsal incision, soft tissue dissection, excision of the medial eminence, realignment of the metatarsal, and fixation placement across the joint.

Code 28297 can also encompass the removal of excess bone from the dorsomedial, dorsal, or dorsolateral areas of the metatarsal head, and possibly the base of the proximal phalanx. These steps can be executed with or without any necessary soft tissue corrections, releases, or resections.

Take note: Your podiatrist will perform a 28297 procedure 鈥渢o correct a hallux abductovalgus deformity with associated long first metatarsal, hypermobile first ray or instability in the first metatarsocuneiform joint, high medially deviated first metatarsocuneiform angle, arthritic changes in the first metatarsocuneiform joint, and/or failed first ray osteotomy,鈥� according to CPT^庐 Assistant, Volume 26, Number 12.

鈥淐ode 28297 includes the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head (distal metaphysis) along with first metatarsal and medial cuneiform joint arthrodesis, and may additionally include the resection of excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head, and/or base of the proximal phalanx with or without related soft-tissue correction, resection, or release,鈥� per CPT^庐 Assistant. 鈥淐ode 28297 may also involve tendon and other soft tissue balancing and/or the removal of one or both sesamoids.鈥�

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC