06/12/2018
Proper Coding for Keller Bunionectomy with Hemi Implant
What is the proper CPT coding and modifiers for Keller bunionectomy with hemi implant?
The correct CPT code for a Keller bunionectomy is 28292
28292
Correction hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method
Lay Description (Code):
The physician surgically corrects a bunion of the foot by any method (Keller, McBride, Mayo, etc.). The physician makes an incision along the medial aspect (inside) of the big toe. The incision is carried deep to the metatarsophalangeal joint. In a Keller procedure, the median eminence and one-third of the base of the proximal phalanx are resected. This is followed by repair of the plantar plate and stabilization with a longitudinal K-wire. In a McBride procedure, the adductor tendon and transverse metatarsal ligament are released through an incision made between the first and second toe. Following the release of the contractured lateral structures, the subluxated first MP joint is reduced and the median eminence is excised. The medial capsule of the first MP joint is imbricated through a medial arthrotomy incision. In a Mayo procedure, the first metatarsal head and its articular cartilage are removed and the remaining bone is restructured. Excision of a medial exostosis is performed. The external joint capsule is configured so that it can be used as cartilage between the metatarsal bone and the base of the first proximal phalanx. Fixation devices may hold the bone fragments in position. The procedure includes a sesamoidectomy and resection of the proximal phalanx base, when performed. The wound is closed in layers after thorough irrigation.
Coding Tips
To correct severe hallux valgus deformities, this procedure may be used in combination with other techniques. When used in combination with other methods (e.g., double osteotomy), see 28299. According to CPT guidelines, cast application or strapping (including removal) is only reported as a replacement procedure or when the cast application or strapping is an initial service performed without a restorative treatment or procedure. See "Application of Casts and Strapping" in the CPT book in the Surgery section, under Musculoskeletal System. For radiology services, see 73620-73660.
The procedure code for a semi implant done concurrently with a bunionectomy is 28291
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.
Coding Tips
For treatment of arthritic changes involving partial ostectomy, exostectomy, or condylectomy of the metatarsophalangeal head only, see 28288. For radiology services, see 73620-73660.
The associated diagnosis codes reported with these surgical procedures are:
M20.11: Hallux valgus (acquired)
M20.12: Hallux valgus (acquired)
M20.21: Hallux rigidus, right foot
M20.22: Hallux rigidus, left foot
M20.42: Other hammer toe(s) (acquired), left foot
M20.41: Other hammer toe(s) (acquired), right foot
If both procedures are performed on the same joint, CPT 28291 should be reported along with the appropriate T modifier since 28292 is considered a component of 28291 per current CCI edits. If documentation supports both procedure codes being billed for the DOS, they should be indicated by different T modifiers.