Implications of Recent Changes in Bunionectomy Coding

In 2017, podiatry practices and their medical billing and coding companies saw several changes and updates in bunionectomy coding. In addition to new bunion and bunionette ICD-10-CM codes, major changes have been made to some bunion surgery CPT codes to update them depending on current methods of the repairs.

Prelude to the 2017 ICD-10 Bunion Code Additions

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Before we go into the 2017 diagnostic code changes, let’s see how ICD-10 simplified Bunion Coding from ICD-9.

In ICD-9, there were two separate codes for bunions based on the deformity.

727.0, (Synovitis and tenosynovitis) was used for a bunion without the toes overlapping 727.1 (Other disorders of synovium, tendon, and bursa; bunion) was used for bunions with hallux valgus, where the toes overlapped

ICD-10 introduced specificity and changes the codes for bunions as:

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M20.10 Hallux valgus (acquired) unspeci¬ed foot M20.11 Hallux valgus (acquired), right foot M20.12 Hallux valgus (acquired), left foot

A sixth character addressing laterality is required (1 = right, 2 = left, and 9 = unspecified). However, though hallux valgus included bunion, there was no indication of bunionette or baby bunion. This led the American Podiatric Medical Association (APMA) to point out to CMS that a bunion is a different deformity from hallux valgus and that a bunionette is also a distinctly different deformity. This resulted in the 2017 ICD-10 additions.

2017 ICD-10 Code Changes for Bunions and Bunionettes

Reporting a bunion using code M20.1-Hallux valgus (acquired) is no longer correct. The right codes to use in 2017 are:

Bunions (M21.61-)

M21.611 bunion of right foot M21.612 bunion of left foot M21.619 bunion of unspecified foot

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Bunionettes: (M21.62-)

M21.621 bunionette of right foot M21.622 bunionette of left foot M21.629 bunionette of unspecified foot

CPT Codes for Bunionectomy – Major Changes in 2017

The procedural code changes for bunionectomy include 2 new codes, 6 revised codes and 3 deleted codes.

• • New CPT codes: 28291 and 2829528291 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant Code 28291 was added to provide a code to report hallux rigidus correction with implant; code28289 already existed for hallux rigidus correction without implant. 28295 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method Code 28295 was added to introduce reporting of correction of hallux valgus (bunion) with sesamoidectomy and removal of the base of the proximal phalanx (first toe bone), when performed; the existing bunionectomy codes specify “with or without” sesamoidectomy

• Revised CPT codes: 28289, 28292, 28296, 28297, 28298 and 2829928289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant 28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method 28296 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method 28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method 28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method CPT 28299 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method 28299 was clarified showing 3 surgical options for “double osteotomy”: – Bunionectomy with distal 1st metatarsal osteotomy and hallux proximal phalanx osteotomy – Bunionectomy with proximal 1st metatarsal osteotomy and hallux proximal phalanx osteotomy – Bunionectomy with distal and proximal 1st metatarsal osteotomies
• Deleted CPT codes Codes 28290, 28293, 28294 were deleted
• Points to note: – Name-related procedures were deleted – The revised codes no longer include legacy-named procedures such as Keller, McBride, Mayo, Mitchell, Chevron, and concentric- and Lapidus-type procedures – All of the new and revised bunionectomy codes now read “sesamoidectomy, when performed,” instead of “with or without”

Choosing the Right Code for Bunion Correction

The American Medical Association’s (AMA) CPT® Assistant defines all hallux valgus (bunionectomy) procedures as including the following:

• Removal of the bony prominence (bunion)
• Removal of additional osteophytes
• Arthrotomy
• Capsulotomy
• Tenotomy
• Tendon releases
• Tenolysis
• Placement of internal fixation
• Removal of bursal tissue
• Articular shaving at the first metatarsophalangeal joint

Coders in medical coding companies will carefully review all the codes to choose the right code for bunion correction.

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