Podiatry Coding & Billing Alert

MPFS to Reduce Bunionectomy Payments

The new CPT^® codes for 2017 are out, and there’s big news for bunions. And, somewhat unsurprisingly, CMS has decided to provide less compensation for them in their proposed Medicare Physician Fee Schedule for 2017.

The changes most significant to podiatry coders are those in series 28290-28299. Changes were based on the rationale that more accurate descriptors were needed.

The CPT^® Editorial Panel created two new CPT^® codes (28291, 28295), deleted CPT^® codes 28290, 28293, 28294 and revised CPT^® codes 28289, 28292, 28296, 28297, 28298 and 28299.

Surprisingly, the removal of 11752 does lead to the positive change of breaking the coding into the two separately chargeable procedures it is.

• Deleted  - 11752 
  
       o For the bone removal, use: 28124 or 28160
       o 11750 for removal of the nail
  
  
• Revised - 77002
• Deleted – 28825

All about the bunions, baby

In addition to the new ICD-10 codes for bunion (M21.61-) and bunionette (M21.62), podiatry coders must pay attention to CPT^® changes in 28290-28299.

Note: CPT^® is keeping hallux valgus and bunion in the same code, unlike ICD-10.

The CPT^® changes and additions aren’t groundbreaking. The “new” procedures aren’t really new but redefined, and the general descriptor of 28299 is revised to be more specific.

New:

28295 — Correction, Hallux Valgus (bunionectomy) with sesamoidectomy, when performed with proximal metatarsal osteotomy, any method
28291— Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant

Deletions:

28290, use: 28292 — Correction, Hallux Valgus (bunion) with or without sesamoidectomy; Keller, McBride, Mayo type
28293, use: 28291
28294, use: 28899 — Unlisted procedure, foot or toes

RVUs on the decline for bunion procedures

Meanwhile, CMS reviewed RVUs on the bunion code category and reduced their relative value units (RVU) across the board in the proposed 2017 MPFS, essentially lowering the amount you’re compensated for performing the procedures.

Also, while the new 28295 code has an increased level of complexity because of the sesamoidectomy, CMS has decided that it should receive equal compensation to a 28296 (Correction, Hallux Valgus [bunion] with or without sesamoidectomy; with metatarsal osteotomy [e.g., Mitchel, Chevron, or concentric type procedures]). The rationale used in the proposed fee schedule is that it doesn’t require much more time, though the procedure itself is markedly more complicated.