“I have a patient who will undergo a Cartiva implant procedure for hallux limitus/rigidus at the 1st metatarsophalangeal joint. He also has lateral deviation of his hallux on the same foot and an Akin osteotomy will be performed to address this deformity. Should the Akin osteotomy be billed as a separate procedure or is that considered unbundling?”
The primary procedure that is being performed is for the correction of the hallux rigidus that is present within the 1st metatarsophalangeal joint. This is billed using CPT code 28291 which is defined as: Hallux rigidus correction with cheilectomy, debridement and capsular release of the 1st metatarsophalangeal joint; with implant. The assumption is that the Cartiva implant is covered by the health insurance carrier that covers the patient in question. An osteotomy is additionally being performed within the proximal phalanx of the great toe to straighten the lateral deviation that is present. This osteotomy procedure is billed using CPT code 28310 which is defined as: Osteotomy, shortening, angular, or rotational correction; proximal phalanx, first toe (separate procedure). How is this scenario coded?
The primary procedure that is being performed is for the correction of the hallux rigidus that is present within the 1st metatarsophalangeal joint. This is billed using CPT code 28291 which is defined as: Hallux rigidus correction with cheilectomy, debridement and capsular release of the 1st metatarsophalangeal joint; with implant. The assumption is that the Cartiva implant is covered by the health insurance carrier that covers the patient in question. An osteotomy is additionally being performed within the proximal phalanx of the great toe to straighten the lateral deviation that is present. This osteotomy procedure is billed using CPT code 28310 which is defined as: Osteotomy, shortening, angular, or rotational correction; proximal phalanx, first toe (separate procedure). How is this scenario coded?
Furthermore, this is carried out by appending modifier 59 to the specific, “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries). What should we do?
Now, I am a real conservative, “by the book” guy. However, it is apparent that CPT code 28291 is NOT going to achieve the total, desired result of this surgical encounter, that is, to not only eliminate the painful, stiff 1st MTPJ, but also to correct the laterally deviated great toe. Therefore, I feel that in this situation, it would be appropriate to additionally bill for the straightening of the great toe, as well. I feel that it would be a “separate procedure.”
The coding scenario would be:
CPT 28291 – RT/LT
CPT 28310 – 59, T5/TA
This is my opinion.
Dr. Michael G. Warshaw
DPM, CPC
THE 2019 Podiatry Coding Manual is available in either Book or Flashdrive formats. Many offices across the country consider this to be their “Bible” when it comes to coding, billing and documentation. The price is only $125 including shipping! To purchase, access the website drmikethecoder.com.
Are you in compliance with Medicare concerning your billing, coding and documentation? An audit should never be more than an inconvenience. It should not be a life altering event. Find out your status before you are audited by your Medicare carrier. Drmikethecoder special: Have 5 dates of service audited for $250 (new clients only). Contact drmikethecoder.com for more information.
Read Comments