Question Bunionectomies

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Benton, LA
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I have a physician who wants to bill two bunionectomy codes together ( 28295 & 28298) on the left TA big toe. We are under the impression that you can't bill two bunionectomy codes together since you can only have and remove one bunion on each foot. He did do the bunionectomy and two osteotomies. We are thinking it needs to be 28298 & 28310 or 28299. Can someone point me in the direction of a credible source (ie AAOS, AAPC, CMS) for documentation that I can present for my argument. We can't seem to find an article that addresses this question. Are we over thinking this? This physician is very hands on?
 

nickelclaw

Guru
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Peru, IN
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Hello depends on where the osteotomies were. For 28295 it would be the proximal metatarsal (above toe) and 28298 for the proximal phalanx (toe). If both were done with bunionectomy code would be 28299 and nothing else.
from 2017 is the only reference on this site

Below is from CPT assistant 04/2016 most current
Bunionectomy including proximal phalanx osteotomy and osteotomy of metatarsal base instead of metatarsal head
CPT Assistant, April 2016 Page: 8 Category: Frequently Asked Questions
Related Information
Surgery: Musculoskeletal System
Question:
What is the appropriate code(s) to report a bunionectomy, which includes a proximal phalanx osteotomy and an osteotomy of the metatarsal base instead of a metatarsal head?

Answer:
Code 28299, Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy, is reported for a bunionectomy that includes two osteotomies.
CPT® Assistant copyright 1990-2022 American Medical Association. All rights reserved.

From coding clinic 1st quarter 2012 most current:
Austin-Akin osteotomy, correct reporting
Coding Clinic for HCPCS - First Quarter 2012 Page: 6
Related Information
QUESTION 8
A patient underwent an Austin-Akin osteotomy at our facility and we need assistance in the correct code assignment for this procedure. The Austin-Akin procedure has been defined as a double osteotomy and is usually performed on the proximal phalanx and distal metatarsal or double osteotomy of the metatarsal. We currently report CPT code 28299, Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy, for this procedure. Recently, an Austin-Akin osteotomy was performed and the physician documented the medial phalanx as opposed to the proximal phalanx. Would this still be coded as an Austin-Akin procedure since it was performed on the medial phalanx instead of the proximal phalanx? Any guidance you can provide would be greatly appreciated.

ANSWER
Report CPT code 28299, Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy, for the Austin-Akin osteotomy performed on the medial phalanx. The Akin osteotomy portion of the procedure is a medial closing wedge osteotomy performed at the level of the proximal phalangeal base.
 

amyjph

Expert
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Munising, MI
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28299 for "double" procedures.
Some providers will argue they want to report two separate codes for procedures like "Lapiplasty". Some will also try to get you to separately report parts like 28306, 28307, 28104 but these are generally considered inclusive.
The advice from Nichole above is correct and from official sources. If you have a copy of the AAOS Global Service Data books it tells you this as well. "If the deformity is corrected by a double osteotomy, report 28299." You can look in here to see what is included in the bunion codes.
It doesn't have anything to do with the fact that "you can only have one bunion", it has to do with the exact procedures performed to correct it, and if those involve osteotomy, soft tissue only, etc.
Older AAPC article with some info: https://www.aapc.com/blog/37841-stand-up-for-better-bunionectomy-coding/
 
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