Stand Your Ground on Bunionectomy Coding
Keep your podiatry claims clean and your resources up to date. Bunionectomies are among the most common procedures performed in podiatry practices. The codes used in the CPT® code book have undergone some subtle changes that have made big differences in the way these procedures are now coded and paid since January 2024. This in turn can change the way practitioners may expect you to code those procedures as well. Whether your podiatry practitioners are hands-off or hands-on during the coding process, there was a lot of valuable bunionectomy information shared during Jeffrey D. Lehrman’s, DPM, FASPS, MAPWCA, CPC, CPMA, HEALTHCON 2025 presentation: “Coding and Compliance: Foot & Ankle Surgery.” Lehrmann opened with a discussion focused on warning providers against “approximating” the work that they do. Being told this can be upsetting to practitioners because in many cases, they may not be aware they receive the same payment regardless of the amount of work completed, even with patients who undergo complicated bunionectomies with additional work involved. Whether the procedure is distal or proximal, it will now be covered under one code. The practitioner may still fight to unbundle codes thinking they can receive additional payment, but Lehrman stressed that this isn’t the case anymore, and as coders, it’s our job to educate them. Use Updated Resources Lehrman shared with the audience that every few months he’s asked by a surgeon, “I tried billing codes 28290, 28293, or 28294 and they were denied. What happened?” Unfortunately, those codes were deleted in 2017. Lehrman added, “Of course, the surgeon is using an old book or an old cheat sheet at his desk.” He stressed the importance of always having the most up-to-date information at your fingertips. He warned the audience to stay on top of coding updates and guideline changes so you aren’t facing claim denials for unnecessary reasons. Focus on Bunionectomy Language Bunion defined: First, Lehrman explained that bunions are not an extra growth of tissue or bone, but a condition that occurs when the first metatarsal is no longer straight behind the great toe, or no longer parallel to the second metatarsal. There are a few different options to repair the deformity. One solution — the process of straightening the first metatarsal — is what comprises a bunionectomy. Where it becomes confusing to most people, Lehrman stressed, is per the CPT® code book, a bunionectomy is shown in diagrams as being a resection of the metatarsal head (meaning a portion has been removed) even if the practitioner has instead used internal fixation (a metal plate and screws) to straighten the first metatarsal, which then removes the bunion without any further surgical shaving or sawing. So, even though to the practitioner this process of using internal fixation is still technically performing a bunionectomy, CPT® doesn’t see it that way. “If we submit a code that has the word ‘bunionectomy’ in it, they must have resected the medial eminence of the first metatarsal head. They must have resected the bump. If we have an operative [op] note where they did not remove the bump because they [used internal fixation], that is fine. But from a coding perspective, if the op note does not describe removal of the bump, we can’t use a bunionectomy code, and oftentimes [the doctors] don’t understand that, and they have lots of questions about it,” said Lehrman. In January of 2024, the following bunionectomy codes were changed to remove (bunionectomy) in parentheses and instead all were changed to “with bunionectomy” instead: Lehrman told the audience that the rationale for the language change can be found in CPT® Changes 2025: An Insider’s View. “Previously the descriptors for codes 28292 and 28295-28299 did not specify that bunionectomy is required for reporting these codes. As a result, many users mistakenly believed that the codes in the 28292 code family may be used if a hallux valgus correction had been performed regardless of whether a bunion was resected or not. Therefore, the addition of the term ‘with’ to precede bunionectomy and removing the parentheses from ‘bunionectomy’ in the main [parent] descriptor for these codes clarify that the corrective measures reported by codes 28292 and 2895-28299 should inherently include the removal of the bunion by excision or resection.” Unfortunately, according to Lehrman, this didn’t help with the confusion amongst his colleagues. Using the example of the language included within the CPT® code book specifically, he states, “every word, every letter, every punctuation mark matters. If it’s there [in the CPT® code book], it’s there for a reason.” He stressed that when it comes to bunionectomies and sesamoidectomies, CPT® has recently been updated to include language like “when performed” to make coding clearer for both the coder and the practitioner. He reminded the audience that the CPT® code book has instructions on how to properly choose codes and warns against choosing codes that are merely approximating the work being done. “It can’t be close, it can’t be kinda … there’s no wiggle room here,” he said. Know the Lingo There are a few terms to learn when it comes to coding bunionectomies correctly. For example, when coding for a bunionectomy procedure with a distal metatarsal osteotomy, the op note might mention that the provider carried out a “Mitchell.” This is just another name for a distal metatarsal osteotomy and would be coded as 28296. “At that point, if you’re still unsure, you can give them [the practitioner] the dreaded yellow sticky note [to query them] or do some research on your own. What matters to us is whether it was distal or it was proximal,” Lehrman stated. Lehrman warned that many practitioners may try to unbundle codes and services for two reasons — either they are unclear as to how to correctly code the services they are performing, or they believe if they break down something covered by one code into multiple codes instead, they can collect additional payment. Most coders know this goes against coding practices and will lead to claim denials and, possibly, future audits. Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
