”We’re having a debate on coding for the diagnosis of primus varus versus the diagnosis of hallux valgus. When measuring angles, most patients have both a first intermetatarsal angle greater than 9 degrees (for primus varus) and a hallux abducto valgus angle greater than 15 degrees (for hallux valgus). Would we bill for both diagnosis codes? These are the diagnosis codes we use when billing our Lapidus bunionectomies.”
This is a good question. Let’s first take a look at the definitions for both metatarsus primus varus and hallux valgus. Metatarsus primus varus is a foot deformity where the first metatarsal bone, which connects to the proximal phalanx bone of the big toe, is rotated and angled away from the second metatarsal bone. Hallux valgus deformity is a very common pathological condition which commonly produces painful disability. It is characterized as a combined deformity with a malpositioning of the first metatarsophalangeal joint caused by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone.
It appears that both definitions address the medial deviation of the first metatarsal from the second metatarsal. It appears that only the definition of hallux valgus addresses both deformities that are at issue, the medial deviation of the first metatarsal from the second metatarsal and the lateral deviation of the great toe. However, doesn’t the medial deviation of the first metatarsal result in a hallux valgus/bunion deformity?
The diagnosis codes in question:
M20.11 – Hallux valgus (acquired), right foot
M20.12 – Hallux valgus (acquired), left foot
M20.5X1 – Other acquired deformities of toe(s) (acquired), right foot
M20.5X2 – Other acquired deformities of toe(s) (acquired), left foot
The big question is: When a Lapidus bunionectomy is performed, are the diagnosis codes for both hallux valgus and metatarsus primus varus necessary?
I believe that it all comes down to the definition or the description of the CPT/procedure code that is being performed. The definition of CPT code 28297 is the following: Correction, hallux valgus(bunionectomy),with sesamoidectomy, when performed, with 1st metatarsal medial cuneiform joint arthrodesis, any method.
Based upon the definition of the code in question, CPT 28297, the only ICD-10-CM codes that are needed are M20.11 or M20.12.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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