How To Use CPT Code 28296

CPT 28296 refers to the correction of hallux valgus (bunionectomy) with sesamoidectomy, when performed, and distal metatarsal osteotomy. This article will cover topics such as the description, procedure, qualifying circumstances, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 28296.

1. What is CPT 28296?

CPT 28296 is a medical procedure code used to describe the surgical correction of hallux valgus, commonly known as a bunion, with sesamoidectomy when performed, and distal metatarsal osteotomy. This code is utilized by healthcare providers to accurately document and bill for the specific services provided during the treatment of a patient with a bunion deformity.

2. 28296 CPT code description

The official description of CPT code 28296 is: “Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method.”

3. Procedure

The 28296 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. An incision is made in the foot over the target area.
3. The incision is deepened to reach the first metatarsal bone.
4. Small vessels along the path are clamped and coagulated.
5. The enlarged bump of bone on the side of the foot is removed using specialized tools.
6. An osteotomy is performed on the metatarsal, and a small wedge of bone is removed.
7. The bones are realigned and fixation devices may be used to maintain the new position.
8. A sesamoidectomy may be performed if necessary, removing one or both sesamoid bones.
9. Bleeding is checked and the incision is closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 28296 services are those who have been diagnosed with a hallux valgus deformity, or bunion, and require surgical intervention to alleviate pain, restore function, and correct the deformity. The decision to perform this procedure is typically based on the severity of the deformity, the level of pain experienced by the patient, and the impact on the patient’s daily activities. Conservative treatment options, such as orthotics or footwear modifications, should have been attempted and proven unsuccessful before considering surgery.

5. When to use CPT code 28296

It is appropriate to bill the 28296 CPT code when the provider has performed a bunionectomy with sesamoidectomy, when performed, and distal metatarsal osteotomy to correct a hallux valgus deformity. This code should be used only when the specific criteria for the procedure have been met, and the patient’s medical record supports the necessity of the surgery.

6. Documentation requirements

To support a claim for CPT 28296, the following information should be documented in the patient’s medical record:

• A thorough medical history and physical examination, including the severity of the deformity and the impact on the patient’s daily activities.
• Documentation of conservative treatment options attempted and their outcomes.
• A clear description of the surgical procedure performed, including the use of sesamoidectomy and distal metatarsal osteotomy.
• Postoperative care instructions and follow-up appointments.
• Any complications or additional procedures performed during the surgery.

7. Billing guidelines

When billing for CPT code 28296, it is essential to follow the specific guidelines and rules set forth by the payer. This may include obtaining prior authorization, submitting accurate and complete documentation, and adhering to any applicable coding modifiers. Additionally, it is crucial to review the patient’s insurance policy to ensure coverage for the procedure and to determine any patient responsibility for copayments, coinsurance, or deductibles.

8. Historical information

CPT 28296 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2017, with the previous descriptor being “Correction, hallux valgus (bunion), with or without sesamoidectomy; with metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures).”

9. Similar codes to CPT 28296

Five similar codes to CPT 28296 and how they differentiate are:

• CPT 28289: This code is used for the correction of hallux rigidus, which involves the removal of bone spurs and joint remodeling, rather than a bunionectomy.
• CPT 28292: This code describes a Keller, McBride, or Mayo type procedure, which involves the removal of the base of the proximal phalanx of the big toe.
• CPT 28293: This code is for a Lapidus type procedure, which involves fusion of the first metatarsocuneiform joint.
• CPT 28294: This code refers to a double osteotomy, which involves two separate bone cuts to correct the deformity.
• CPT 28297: This code is for a bunionectomy with a proximal metatarsal osteotomy, which involves a bone cut closer to the midfoot.

10. Examples

Here are 10 detailed examples of CPT code 28296 procedures:

1. A 45-year-old female with a painful bunion deformity undergoes a bunionectomy with sesamoidectomy and distal metatarsal osteotomy.
2. A 60-year-old male with a severe bunion and limited mobility in the big toe undergoes the 28296 procedure.
3. A 35-year-old female with a recurrent bunion after a previous surgery undergoes a revision bunionectomy with distal metatarsal osteotomy.
4. A 50-year-old male with a bunion and associated sesamoiditis undergoes the 28296 procedure with sesamoidectomy.
5. A 40-year-old female with a painful bunion and hammertoe deformity undergoes a combined bunionectomy and hammertoe correction with distal metatarsal osteotomy.
6. A 55-year-old male with a bunion and metatarsalgia undergoes the 28296 procedure to alleviate pain and improve function.
7. A 65-year-old female with a bunion and associated arthritis undergoes a bunionectomy with distal metatarsal osteotomy and joint debridement.
8. A 70-year-old male with a bunion and hallux limitus undergoes the 28296 procedure with additional joint remodeling.
9. A 30-year-old female with a bunion and an unstable first metatarsal undergoes a bunionectomy with distal metatarsal osteotomy and fixation.
10. A 48-year-old male with a bunion and associated sesamoid pain undergoes the 28296 procedure with sesamoidectomy and realignment of the sesamoid apparatus.