Podiatry Coding & Billing Alert

Are you as brainy about bunions as you think?

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below.

Answer 1: The primary difference between a bunion and a bunionette is location. A bunion is a bump that forms on the inside of the foot at the base of the big toe, causing the toe to drift toward the second digit. A bunionette, also called a “tailor’s bunion,” is an enlargement or bony deformity at the base of the little toe on the lateral side of the bone which causes the little toe to drift toward the fourth digit.

You will need to pay close attention to what the practitioner has noted regarding the location of the bunion to determine whether it is on the first toe or the fifth toe, thus distinguishing between a bunion or a bunionette/tailor’s bunion.

Answer 2: You should report M21.612 (Bunion of left foot) for the bunion. If the podiatrist had documented that the bunion was on the patient’s right foot, then you would report M21.611 (Bunion of right foot). And, if the podiatrist does not specify on which foot the bunion is located, you would report M21.619 (Bunion of unspecified foot). In cases where the podiatrist has failed to note on which foot the bunion is located, you will need to query the provider. Claims without the 6th character will be denied, and payers will often require that your documentation specify the location of the bunion.

Coding alert 1: If the podiatrist documents a bunionette on the left foot, you’ll turn to M21.622 (Bunionette of left foot). Like M21.61-, M21.62 requires a 6th character to specify right, left, or unspecified foot.

Answer 3: “When coding for bunions, analyze the documentation provided,” explains Jeri L. Jordan, CPC, billing manager at Hampton Roads Foot and Ankle in Williamsburg, Virginia. “The operative report may reference legacy-named procedures such as Keller, McBride, or Mayo. All of these procedures are covered by code 28292 [Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method]. Also, when a base resection is done to the proximal phalanx, your documentation will most likely include the placement of a Kirchner wire to hold the joint,” Jordan adds.

The work for 28292 includes your podiatrist removing prominent or hypertrophied bone from the medial aspect of the patient’s first metatarsal head, per CPT® Assistant, Volume 26, Issue 12, December 2016. Your podiatrist may also resect excess bone at the dorsomedial, dorsal, and/or dorsolateral aspect of the metatarsal head and/or base of the proximal phalanx, which is included in the code.