04/02/2019

Correct Coding for Modified McBride Bunionectomy

We know that the bunion codes have recently been changed and some have been deleted. What is the correct CPT code for a modified mcbride bunionectomy? Thank you

The correct code is:

Code Description: 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.