Coding Principles for CPT Code 28297 – Decoding Bunionectomy Procedures
By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Join Paul Cadorette on August 15th at 1pm Central for the Ankle, Foot and Toes Orthopedic Surgery Coding Webinar. Register here.
If you want to ensure that you’re coding a procedure correctly, you’d most likely use published information provided by the AMA. You could reference the CPT Manual, which offers an abundance of AMA coding guidance.
The CPT Manual lists references in the form of CPT Assistant articles. These references can be found in the parenthetical notes listed below a code. They’re issued by the AMA and they’re intended to deliver definitive information related to coding for a particular service.
Ensuring accurate orthopedic coding for procedures like bunionectomy, for example, requires a thorough understanding of the correct uses for CPT code 28297.
In this blog post, I’ll explain the correct coding principles of CPT code 28297. I’ll focus on important takeaways from two CPT Assistant articles from December 2016 and April 2021 related to bunionectomy coding.
Understanding the complexity of bunion deformities
Bunion deformities, specifically hallux valgus, vary in pathology and severity. Therefore, it is vital to define them in terms of complexity rather than considering them as a single deformity.
The December 2016 CPT Assistant article emphasizes the diverse nature of these deformities and lists eight different contributing conditions, two of which are metatarsus primus varus and malalignment of the first metatarsal sesamoid apparatus.
The role of Lapiplasty Techniques
A notable device used to correct hallux valgus is the Lapiplasty technique. This innovative method involves rotating the metatarsal head to realign the sesamoid bones and reduce the intermetatarsal angle. By adopting this technique, surgeons can address specific complexities of the bunion deformity effectively.
Components of surgical correction
The CPT Assistant article provides valuable insights into the surgical correction of bunion deformities by listing 20 different services included in the procedure. However, it is essential to understand that not all 20 services need to be performed in order to use CPT code 28297.
The AMA clarifies that “Bunionectomy procedures include IF PERFORMED the following components.”
By stating “if performed” the AMA is indicating that the 20 listed services don’t all have to be performed, but any of those services are considered part of the bunion correction if they are performed.
Interestingly enough, one of those inclusive services is “resection of medial, dorsomedial, dorsal, and/or dorsolateral bone prominences at the metatarsal head.”
Clarification on excision of medial eminence
A significant question that often arises in bunionectomy coding is whether the excision of the medial eminence is necessary for reporting hallux valgus correction with CPT code 28297.
The CPT Assistant December 2016 article and the subsequent April 2021 article provide valuable answers.
Based on the information presented, it is not mandatory to excise the medial eminence for coding hallux valgus correction with CPT code 28297.
The illustrations in the CPT Manual showcasing excision of the medial eminence are just one treatment example among various pathology and treatments associated with the condition.
The CPT Assistant April 2021 article further supports this clarification: In a scenario where a hallux valgus correction is performed with first metatarsal cuneiform joint fusion, but no bunion excision is involved, CPT code 28297 would be the appropriate code to report.
This reinforces the understanding that the excision of the medial eminence is not a mandatory component for coding hallux valgus correction.
Final thoughts on coding principles for CPT Code 28297
Ensuring accurate orthopedic coding for procedures like bunionectomy requires a thorough understanding of the complexities associated with the condition. By referring to CPT Assistant articles and published information provided by the AMA, medical professionals can gain valuable insights into correct coding principles for CPT code 28297.
Remember, the CPT Manual serves as an authoritative resource, and the AMA’s guidance should be followed for accurate coding and billing. Being aware of the nuances in bunion deformities and the Lapiplasty technique can help surgeons choose the appropriate coding for each unique case, leading to better patient care and proper reimbursement.
Always stay updated with the latest CPT Assistant articles and utilize reliable resources to enhance your coding knowledge and stay compliant in the ever-evolving field of orthopedic coding.
Dive deeper into orthopedic coding in our upcoming webinar
I hope you’ll join me in the upcoming Ankle, Foot and Toes Orthopedic Surgery Coding Webinar, where I’ll delve into additional complex coding issues associated with these procedures.
Ankle, Foot and Toes Orthopedic Surgery Coding
Date: Tuesday, August 15
Time: 1:00pm Central Time
Duration: 1 hour
Register here: https://bit.ly/3KgEx2H
About the Author
Paul Cadorette is an accomplished professional in the field of medical coding, serving as nimble’s Director of Training and Education. With a passion for education and extensive experience, Paul provides comprehensive training and resources to ASC coding professionals, helping them navigate the complexities of medical coding and revenue cycle management. His deep understanding of coding guidelines, documentation requirements, and best practices, particularly in the specialized area of orthopedic coding, enables him to deliver authoritative insights and practical recommendations. With a reputation for effectively translating complex coding concepts, Paul is dedicated to empowering coding professionals to enhance their coding skills and optimize revenue cycle outcomes, ensuring accurate reimbursement in an ever-changing healthcare landscape.
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- CPT Assistant December 2016 page 3
- CPT Assistant April 2021 page 13
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