APMA News - November/December 2017 - 52

Reimbursement
By Jeffrey D. Lehrman, DPM

Coding for Bunion Surgery
Bunion surgery is among the most common procedures performed by podiatrists. You may be well-trained in the preoperative work-up, perioperative care, and postoperative course,
but do you know how to code and document these procedures
properly? The options for bunionectomy codes are listed in the
green box below.
Cheilectomy codes CPT 28289 and CPT 28291 were included because of the work done at the metatarsal-phalangeal joint,
not because they represent bunionectomy codes.
Major changes to the bunionectomy Current Procedural
Terminology (CPT) codes went into effect on January 1, 2017.
CPT codes 28290, 28293, and 28294 were deleted. CPT 28291
and CPT 28295 were added.
According to CPT, a bunionectomy includes the removal of
the medial eminence of the first metatarsal head. For example, if
the medial eminence of the first metatarsal head is removed and
an osteotomy is performed to the distal aspect of the first metatarsal, the correct code selection would be CPT 28296 (1 unit).
Do not make the mistake of coding the above-described proce-

CPT 28289-Hallux rigidus correction with cheilectomy,
debridement and capsular release of the first metatarsophalangeal joint; without implant
CPT 28291-Hallux rigidus correction with cheilectomy,
debridement and capsular release of the first metatarsophalangeal joint; with implant
CPT 28292-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with resection of
proximal phalanx base, when performed, any method
CPT 28295-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with proximal
metatarsal osteotomy, any method
CPT 28296-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method
CPT 28297-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method
CPT 28298-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with proximal
phalanx osteotomy, any method
CPT 28299-Correction, hallux valgus (bunionectomy),
with sesamoidectomy, when performed; with double osteotomy, any method

52 APMA News November/December 2017

dure as a "double osteotomy." The removal of the medial eminence of the first metatarsal head is not an osteotomy but is instead an ostectomy. An example of a "double osteotomy" would
be the performance of independent osteotomies at the level of
the metatarsal head and metatarsal base. If these procedures are
both performed, along with resection of the medial eminence of
the first metatarsal, CPT 28299 (1 unit) would accurately reflect
the work performed.
Note that an osteotomy across the distal first metatarsal without performance of a "bunionectomy" (resection of the medial
eminence) is not to be coded as a bunionectomy with osteotomy
(CPT 28296). The procedure would be coded as CPT 28306 (1
unit), osteotomy with or without lengthening, shortening, or angular correction, metatarsal; first metatarsal.
The APMA Coding Committee hopes this brief outline
provides some guidance regarding the selection of the proper
code to bill based on the bunionectomy procedure that is performed. All the 2017 new, revised, and deleted bunionectomy
codes are covered in greater detail-including examples-in
the APMA Surgical Coding Webinar Series, available free as
an APMA member benefit. The webinar, "Coding for Distal HAV
Surgery," is available on demand at www.apma.org/Surgical
Coding. Another webinar titled, "Coding for Proximal HAV
Surgery," will be presented on January 18, 2018. APMA members can register for that webinar at www.apma.org/working
foryou/EventDetail.cfm?EventID=84378.
n

Dr. Lehrman is a member of the APMA Coding Committee and the
APMA MACRA Task Force, serves as an expert panelist on Codingline, and is a Fellow of the American Academy of Podiatric Practice
Management. Follow him on Twitter @DrLehrman.
Contact the APMA Health Policy and Practice
Committee at healthpolicy.hpp@apma.org.

Subscribe to CRC Today
If you have not subscribed or renewed your APMA Coding
Resource Center subscription, there is no better time than
now to do so. The CRC is a one-stop shop for all your bunionectomy coding needs. Take advantage of having CPT,
ICD-10, HCPCS, Medicare LCDs, CodinglineSILVER, and
more, all available online. Visit www.apmacodingrc.org.

http://www.apma.org/coding http://www.apma.org/coding http://www.apma.org/workingforyou/eventdetail.cfm?eventID=84378 http://www.apma.org/workingforyou/eventdetail.cfm?eventID=84378 http://www.apmacodingrc.org

Table of Contents for the Digital Edition of APMA News - November/December 2017