Bunion Surgery Eponyms
What’s in a Name?
By Heidi Stout, CPC, CCS-P
Foot surgeons use a wide variety of surgical techniques for bunions and hallux valgus correction, and many of these procedures are referenced using an eponym or proper name, such as Austin, Akin, McBride and Lapidus. Unfortunately, not all of these eponyms are listed in CPT®; and because these terms give no information about which technique the surgeon used, code selection can be difficult.
Confusing eponym procedures, coupled with the vast array of bunion repair techniques, makes bunion surgery coding difficult even for seasoned orthopedic coders. The CPT® codebook arranges bunion correction codes (28290-28299) in a family. Only the parent code (28290) is printed in its entirety. To determine the complete descriptions for the family codes, the coder must refer back to the parent code. Coders must be aware that the procedures listed in this category all include a set of surgical maneuvers that are considered inclusive to the main surgery.
The AMA has defined a set of procedures that, when performed at the metatarsophalangeal (MTP) joint, are inclusive to the bunion correction codes listed above. The included procedures are: arthrotomy, capsulotomy, synovial biopsy, synovectomy, tendon release, tenotomy, tenolysis, excision of the medial eminence, excision of associated osteophytes, placement of internal fixation, scar revision, articular shaving, sesamoidectomy and removal of bursal tissue. These adjunct services should not be reported separately when performed at the MTP joint of the great toe in conjunction with bunion correction surgery.
Learn the Eponyms and the Codes Will Follow
Coding professionals will find it easier to select the appropriate code once they are aware of the accompanying eponyms. Each bunion correction technique and some of its common eponyms are as follows:
28290 Removal of the bunion on the medial side of the toe. The most common eponym is “Silver.”
28292 Tightening or loosening ligaments and/or tendons to correct imbalance with resection of the base of the proximal phalanx or head of the distal metatarsal. Common eponyms are “Keller,” “McBride” and “Mayo.”
28293 Removal of the damaged joint surfaces with prosthetic replacement. This is the only bunion procedure with no associated eponym.
28294 Tendon transplant to correct imbalance. The most common eponym is “Joplin.”
28296 Osteotomy of the distal metatarsal. Common eponyms include “Mitchell,” “Chevron,” “Austin,” “Kalish,” “Youngswick,” “Reverdin,” “Reverdin-Green” and “Hohmann.”
28297 Fusion of the first tarsometatarsal joint plus distal soft tissue bunion repair. The most common eponym is “Lapidus.”
28298 Osteotomy of the proximal phalanx. The most common eponym is “Akin.”
28299 A double osteotomy, either of the proximal phalanx and distal metatarsal or double osteotomy of the metatarsal. Common eponyms include “Logroscino and “Austin-Akin.”
Some eponym procedures include a combination of techniques that cannot be captured in a single code. One of the most common is a distal soft tissue realignment (28292) combined with proximal first metatarsal osteotomy (28306). Common eponyms are “Ludloff,” “Scarf” and “Juvara.”
While this article does not present a complete review of all bunion surgery techniques, the information provided should assist coders in navigating the path of linking eponyms to their corresponding CPT® codes. Coders should keep a list of eponym procedures and their associated codes, updating it as needed.
- 28296. 28297
- articular shaving
- bursal tissue
- excision of associated osteophytes
- excision of the medial eminence
- hallux valgus
- placement of internal fixation
- scar revision
- synovial biopsy
- tendon release