05/24/2023

BCBS Denial for 28296 with dx M20.11

BCBC has denied CPT Code 28296 with Diagnosis M20.11 as : M-51 Missing/Invalid/Incomplete procedure code. Is there a more current code to bill?

The denial from BlueCross is incorrect and should be appealed. CPT 28296 is still currently valid to bill for a bunionectomy. If the following was performed according to the guidelines of the procedure and description:

28296

Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method

The diagnosis code billed is appropriate for a procedure performed on the right foot. The T modifier reported is correct based on the diagnosis and the insurance’s requirements to cover the surgical service. This service should be paid by BlueCross with the information provided.