12/08/2023    

RESPONSES/COMMENTS (CODING ISSUES)

RE: New Bunionectomy Language for 2024 (Michael G. Warshaw, DPM)

From: Charles Morelli, DPM

 

In a recent publication of coding pearls published by Dr. Warshaw in TLD newsletter, he states that effective January 1, 2024, there will be changes to the definitions/descriptions of the CPT codes for Correction of Hallux Valgus deformities, and he goes on to list those changes. My question is about the CPT code 28297 (Lapidus-type of procedure), which states the following: "28297 Correction, hallux valgus with bunionectomy, with sesamoidectomy; when performed, with first metatarsal and medial cuneiform arthrodesis, any method."

 

This is pretty standard language, but at the end of his article he goes on to say the following, "The bottom line is that in order to bill any of the above CPT codes and support their performance with the proper documentation, a “bunionectomy” needs to be performed in addition to any other corrections/procedures that are stated within the definition of the CPT code. A bunionectomy is the removal or the excision of the medial aspect of the head of the 1st metatarsal. If this is not performed, then it would be inappropriate to bill any of the CPT codes listed and defined above."

 

It is not unusual when performing a Lapidus-type of procedure to not always have to address the first metatarsal head, either with an osteotomy or with a simpler excision of the medial eminence. Are we now being told that we are being forced to do work on the first metatarsal head when doing a Lapidus-type of procedure, even though it may not be necessary in order to properly bill CPT code 28297?

 

Charles Morelli, DPM, Mamaroneck, NY

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12/09/2023    

RESPONSES/COMMENTS (CODING ISSUES)

RE: New Bunionectomy Language for 2024 (Charles Morelli, DPM)

From: Michael G. Warshaw, DPM, CPC

 

Within the Coding Pearls article that I wrote that was published in the most recent TLD Newsletter, I addressed the changes that were going to take effect on January 1, 2024 with respect to the CPT codes for the Correction of Hallux Valgus Deformities that specifically address CPT codes 28292, 28295, 28296, 28297, 28298 and 28299. The specific issue at hand that was brought up by Dr. Charles Morelli was in reference to CPT code 28297.

 

Prior to January 1, 2024, the definition of CPT code 28297 has been the following: Correction, hallux valgus [bunionectomy], with sesamoidectomy; when performed, with first metatarsal and medial cuneiform arthrodesis, any method. Based upon this definition, the terms correction, hallux valgus, and bunionectomy appear to be...

 

Editor's note: Dr. Warshaw's extended-length letter can be read here.