Podiatry Coding & Billing Alert

Don’t miss: There are special ICD-10 codes you should use when reporting bunionettes.

In your podiatry office, you may encounter patients who suffer from bunions, a very painful and common condition. You will have several CPT® and ICD-10 options when it comes to your bunion claims, so make sure you know where to turn to.

Read on to hone your bunion coding smarts.

First, Define Bunions for Clarity

Bunion defined: “A bunion is enlargement of the bone on the medial and/or dorsal aspect of the first metatarsal bone,” explains Arnold Beresh, DPM, CPC, CSFAC,  in West Bloomfield, Michigan. “Hallux abducto valgus refers to the position of the tip of the first toe turning towards the second toe.”

Technically, a bunion deformity and hallux valgus are not the same although the terms are often used synonymously, Beresh continues. Also, some insurance companies will not pay for an osteotomy procedure when the term or diagnosis of bunion is used without hallux abducto valgus.

Look to These ICD-10 Options for Bunions

When it comes to your ICD-10 choices for bunions, you can look to the following options:

• M21.611 (Bunion of right foot)
• M21.612 (Bunion of left foot)
• M21.619 (Bunion of unspecified foot).

For example: The podiatrist documents that the patient suffers from a bunion on her left foot. You would report M21.612 for this condition.

Don’t Mix Up These CPT^® Bunionectomy codes

If you need to report CPT^® codes for bunionectomy procedures, you should look to the following:

• 28292 (Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method)
• 28295 (…; with proximal metatarsal osteotomy, any method)
• 28296 (…; with distal metatarsal osteotomy, any method)
• 28297 (…; with first metatarsal and medial cuneiform joint arthrodesis, any method)
• 28298 (…; with proximal phalanx osteotomy, any method)
• 28299 (…; with double osteotomy, any method).

If you report the above codes, make sure to look closely at the documentation to see what procedures the podiatrist performed. And, you should note, that codes 28292 through 28299 all include a sesamoidectomy when performed.

For more clarity, CPT^® Assistant Vol. 26, No. 12 gives you specific instructions on how to report the bunionectomy codes.

Delve deeper into 28296: Take a look at 28296, for example. This service “includes the removal of prominent or hypertrophied bone from the medial aspect of the first metatarsal head (distal metaphysis) along with distal first metatarsal osteotomy, and may additionally include the resection of excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head, and/or base of the proximal phalanx with or without related soft-tissue correction, resection, or release, according to CPT^® Assistant.

Code 28296, which CPT^® Assistant calls the “most commonly performed bunionectomy procedure,” may also include tendon and other soft-tissue balancing and/or removal of one or both sesamoids.

Podiatrists usually perform a 28296 service “to correct a mild-to-moderate hallux abductovalgus deformity associated with a mild-to-moderate intermetatarsal angle (metatarsus primus varus [adductus]) and/or distal lateral torsional deviation of the metatarsal head,” CPT^® Assistant explains.

Don’t Miss These Bunionette ICD-10 Codes

A bunionette, also called a “tailor’s bunion,” occurs on the outside of the foot near the base of the little toe. Your ICD-10 choices for bunionettes are as follows:

• M21.621 (Bunionette of right foot)
• M21.622 (Bunionette of left foot)
• M21.629 (Bunionette of unspecified foot).

For example: The podiatrist documents that the patient suffers from a bunionette on her right foot. You would report M21.621 for this condition.