“A friend of mine is encouraging me to change how I bill for my Lapidus bunionectomy. I typically bill this using CPT code 28297. I am being told that I should think about billing this “alternatively” as: 1) CPT 28740 2) CPT 28292 Thoughts on this?”
Let’s look at the CPT codes involved.
CPT code 28297 is defined as: Correction, hallux valgus [bunionectomy], with sesamoidectomy; when performed, with first metatarsal and medial cuneiform arthrodesis, any method
CPT code 28740 is defined as: Arthrodesis; midtarsal or tarsometatarsal, single joint
CPT code 28292 is defined as: Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed. with resection of proximal phalangeal base, when performed, any method
The question at hand is how to bill for a Lapidus bunionectomy? This appears to be a no brainer. CPT code 28297 completely and accurately describes what is known as a Lapidus bunionectomy. Unfortunately, there always seems to be a suggestion to perform “creative billing” or “unbundling.” At face value, why unbundle the component parts of the Lapidus bunionectomy when CPT code 28297 is the appropriate CPT code to bill for the procedure? The answer is very simple: to try to get more money! Why else?
When you access CPT codes 28740 and 28292 within the CCI edits, they are not bundled. So far, so good.
When you do the math, based upon the national average facility reimbursement:
CPT code 28297 reimburses approximately $627.96
CPT code 28740 reimburses approximately $646.00
CPT code 28292 reimburses approximately $502.73
Based upon the above, if a Lapidus bunionectomy is performed, the reimbursement is approximately $627.96. If the component parts of the Lapidus bunionectomy are unbundled, the reimbursement will be 100% for CPT code 28740 and 50% for CPT code 28292 which comes to approximately $897.37. So, the bottom line is that if you dissect CPT code 28297 into the component parts, the reimbursement is $269.41 greater. Not a bad deal.
The problem is that CPT code 28297 INCLUDES the two procedures that can cleverly be unbundled and billed separately for a greater reimbursement. Unfortunately, unbundling, while creative and smart, is inappropriate to perform. The moral of the story is that if there is a CPT code that describes all of the procedures that are going to be performed on a designated date of service, at the same surgical session, at the same anatomical site that is the CPT code that should be billed.
This is my opinion.
Dr. Michael G. Warshaw
DPM, CPC
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