05/04/2017

Coding for a Long Arm Chevron Osteotomy Correcting a Hallux Valgus Deformity Along With a Cartiva Procedure

I just asked the question on the cartiva implant and was told to use 28291. no where in that code does the description discuss performing a metatarsal osteotomy at the same time. This was the point of the question. so the long arm chevron with 2 screw fixation was done for free? it is bundled into the hallux rigidus? that would seem highly unfair.

It is possible to bill 28291 with CPT code 28306 and append a 59 modifier. Some insurances may bundle this, as there is a CCI edit conflict, in which case you would need to submit surgical op reports.

28291- Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant

Lay Description Code: The physician corrects a hallux rigidus deformity and performs a cheilectomy. Hallux rigidus is a condition caused by degenerative (DJD) arthritic changes at the first metatarsophalangeal joint, causing pain, limited range of motion, and dorsiflexion. In the context of this procedure, a cheilectomy refers to excision of part of the lip of the first metatarsophalangeal joint. The podiatrist makes a dorsal incision over the first metatarsophalangeal joint. The extensor hallucis longus tendon is retracted and the joint capsule is entered. Osteophytes and part of the metatarsal head are excised. Bony irregularities may be removed using a chisel and edges smoothed with a rasp. When adequate dorsiflexion (60 to 80 degrees) is obtained, the capsule is closed, the tendon is returned to its correct anatomical position, and the skin is closed with sutures. Report 28291 when the procedure includes an implant.

28306-Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal

Lay Description Code: A dorsomedial incision is made over the big toe and the skin and soft tissues are reflected. In many cases this procedure is performed in an effort to correct the poor alignment of the big toe. In addition to removal of the medial eminence, a cut is made through the metatarsal shaft and a portion of the bone is removed in order to correct the alignment of the bone. Wires are used to reattach the bone in its corrected alignment. Sutures are used to close the incision. Weight bearing is protected for several weeks. Report 28307 if a bone graft is used to correct the alignment of the first metatarsal shaft and attached with wire or screws. Report 28308 if the procedure is performed on other metatarsal bones.