12/09/2023    Michael G. Warshaw, DPM, CPC

New Bunionectomy Language for 2024 (Charles Morelli, DPM)

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 synonymous.
Therefore, in theory, if a hallux valgus
correction is carried out by performing an
arthrodesis at the base of the 1st metatarsal with
the articulation of the medial cuneiform, it would
be appropriate to bill CPT code 28297.

As of January 1, 2024, it was determined that
opposed to billing and coding based upon theory,
it would be much more appropriate to have a
definitive definition of all the CPT codes that
designate a hallux valgus correction, in this
instance CPT code 28297. At the start of the
calendar year, the new definition of CPT code
28297 will be the following: Correction hallux
valgus with bunionectomy, with sesamoidectomy when
performed, with first metatarsal and medial
cuneiform arthrodesis. The definition of
bunionectomy is quite simple. It involves the
removal or the excision of the medial aspect of
the head of the 1st metatarsal. Therefore, to bill
CPT code 28297, both an arthrodesis of the base of
the 1st metatarsal and the medial cuneiform need
to be performed AND the medial aspect of the head
of the 1st metatarsal needs to be excised aka the
bunionectomy.

Dr. Morelli opines that “it is not unusual when
performing a Lapidus-type of procedure to not
always address the first metatarsal head, either
with an osteotomy or with simple excision of the
medial eminence.” I cannot argue with his opinion.
However, as of January 1, 2024, if an arthrodesis
is performed at the base of the 1st metatarsal and
the medial cuneiform, but the medial aspect of the
head of the 1st metatarsal is not performed, the
correct CPT code to bill is not 28297, but 28740
which is defined as the following: Arthrodesis;
midtarsal or tarsometatarsal, single joint.

Michael G. Warshaw, DPM, CPC, Mount Dora, FL

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