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28315(sesamoidectomy) with 28292, 28293, 29296(bunionectomy)

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The cpt description for the 28292, 28293 & 28296 (Correction, Hallux Valgus - bunion) all include in the CPT description with or without sesamoidectomy (28315). My provider states that "sesamoidectomies are only billed by him when circumstances are extenuating and that includes sever arthritic changes where the sesamoid apparatus is arthritic and infused to one another and to the metatarsal. This is not part of the procedure described (28292, 28293, 28296) and is a separate procedure. He also references that there are modifiers that can be used when extenuating circumstances fall under the situation".

Any additional information or feedback would be appreciated. If there are specific resources that your obtain your information from, that would be appreciated as well.
 

TammyHF

Guru
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165
Location
Wichita, KS
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You are correct all the bunionectomy codes do include the sesamoidectomy the only thing that could be done is add a 22 modifier and increase your billed amount for that CPT for the bunionectomy with sesamoidectomy showing that unusual procedural services are provided and submit with documentation showing that this is above and beyond a normal sesamoidectomy was performed with the bunionectomy. Most likely the insurance company will pay at the standard contracted rated. Your podiatrist is most likely thinking if the sesamoidectomy is bill with a 59 modifier it will be paid separately. I would cation against this. I check against the NCCI edits 28315 is considered content of all bunionectomy codes. Hope this is helpful.
 
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