Osteotomy

“I have a patient who had a chevron bunionectomy 10 years ago. The bunion has returned and the head is facing lateral. My plan is to perform a Lapidus procedure to reduce the first intermetatarsal angle and a rotational 1st metatarsal head osteotomy to align the articular surface (basically an Austin with a medial based wedge removed from the dorsal osteotomy to rotate the head slightly medial). How would you recommend I code this (ICD-10 and CPT codes)? Can I use CPT 29297 and CPT 29296? I’ve also considered CPT 28740 with CPT 29296. Thanks.”

“I have great difficulty getting paid for CPT 28308 when a hammer toe repair is performed at the same time. The billing scenario generally will look like this: CPT 28308 (2nd metatarsal osteotomy) -RT CPT 28285 (2nd hammertoe repair) -T1 -59 We never get paid for CPT 28308 in this scenario. Does anyone have any suggestions? We link the acquired deformity of bone diagnosis to CPT 28308.”

“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?”