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Code This!

Scenario Week of June 26, 2007:
View Current Scenario

Assign the correct CPT and ICD-9-CM code(s) for the following scenario:

The patient has a painful bunion of the right foot with severe lateral displacement of the great toe. The surgeon performs an extensive resection of the head of the 1st metatarsal bone and a non-fixated angular osteotomy at the base of the 1st toe proximal phalanx.

For this scenario, CPT code 28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy, would be used to report the osteotomy of the metatarsal and the proximal phalanx. This code includes the procedure and any required fixation. Wires, screws, or pins may be used as internal fixation to hold the correction (osteotomy) of the marked angular deformity in place, but are not necessarily required.

The correct diagnosis code is: 727.1 Bunion

Rational for ICD-9-CM Answer:
The diagnosis in this case is very straightforward. If you look in the ICD-9-CM alphabetical index under the main term “Bunion,” code 727.1 is referenced. When verified in the tabular section, it is confirmed as the correct code.

Rationale for CPT Answer:
The two key elements of the scenario as posed are:

  • Resection of the first metatarsal
  • Angular osteotomy base of first toe proximal phalanx

Additional explanation for this procedure is included in the 2007 CPT Professional Edition on page 119. Example A is described as the resection of the first metatarsal and the osteotomy of the proximal phalanx. The explanation also states, “with placement of appropriate internal fixation (e.g., wire(s), pin(s), screw(s).” Next to the postoperative illustration an additional explanation also indicates that internal fixation “would include screw(s), pin(s), wire(s), as needed.” It is anticipated that the surgeon would perform fixation necessary to ensure the appropriate outcome of the procedure.

Code 28299 is used to report two osteotomies of the same joint, at the same session, and is more appropriate than reporting two separate codes. According to the “Complete Global Service Data for Orthopedic Surgery,” this procedure includes any combination of hallux valgus procedures and all osteotomies of the first metatarsal and the first proximal phalanx. A simple excision of the medial eminence is included in all bunion procedures according to CPT Assistant, January 2007. A simple excision of the medical eminence with the osteotomy of the phalanx would be reported with code 28298.

Besides excision of the medial eminence, all of the codes in the 28290-28299 range include the following procedures which are not separately reported: capsulotomy, arthrotomy, synovial biopsy, neuroplasty, synovectomy, tendon release, tenotomy, tenolysis, excision of associated osteophytes, internal fixation, scar revision, articular shaving, and removal of bursal tissue.


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