Can a hallux valgus correction CPT code be billed if the medial aspect of the head of the 1st metatarsal is not removed?
Let’s first look at the CPT codes that are appropriate for the correction of a hallux valgus deformity.
28292 Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed. with resection of proximal phalangeal base, when performed, any method.
28295 Correction, hallux valgus [bunionectomy], with sesamoidectomy when performed, with proximal metatarsal osteotomy, any method.
28296 Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed, with distal metatarsal osteotomy, any method.
28297 Correction, hallux valgus [bunionectomy], with sesamoidectomy; when performed, with first metatarsal and medial cuneiform arthrodesis, any method.
28298 Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed, with proximal phalanx osteotomy, any method.
28299 Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed, with double osteotomy, any method.
When the CPT definitions are read, in parentheses following the words hallux valgus is the word “Bunionectomy.” The assumption is that a bunionectomy is the removal of the medial aspect of the head of the 1st metatarsal, but over the years the terms bunionectomy and hallux valgus correction have become interchangeable. It is apparent that some clarity is needed.
Effective January 1, 2023, there will be changes put into effect regarding CPT codes 28292, 28295, 28296, 28297, 29298 and 28299.
Prior to January 1, 2024, as described above, the definitions of the hallux valgus correction CPT codes contained the following wording: Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed…
As of January 1, 2024, the definitions of the hallux valgus correction CPT codes will all contain the following wording: Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed…
Clearly, as of January 1, 2024, the hallux valgus correction CPT codes cannot be billed unless the medial aspect of the head of the 1st metatarsal is removed or resected.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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