How To Use CPT Code 28292

CPT 28292 describes the procedure for correction of hallux valgus (bunionectomy) with sesamoidectomy, when performed, and resection of proximal phalanx base, when performed, using any method. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28292?

CPT 28292 is used to describe a surgical procedure that corrects hallux valgus, commonly known as a bunion, on the side of the foot. This deformity causes the big toe to bend towards the second toe, resulting in a bump on the foot. The procedure involves various corrective techniques, such as removing the bony projection of the bunion, releasing tendons or ligaments, removing additional bone structures, and realigning and stabilizing the surgical site.

2. Official Description

The official description of CPT code 28292 is: ‘Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method.’

3. Procedure

1. The provider begins by making an incision in the foot over the target area, reaching the first metatarsophalangeal joint.
2. Small vessels along the path are clamped and coagulated to minimize bleeding.
3. Depending on the underlying causes and the specific procedure required, the provider may resect or remove part of the phalangeal base to ensure proper alignment of the toe.
4. The affected tendons may need to be incised and reattached to fit the corrected position of the toe.
5. A wire or tape is used to hold the straightened toe in position while it heals.
6. If necessary, a sesamoidectomy may be performed to remove a sesamoid bone that is causing pain.
7. The provider checks for bleeding and closes the incision.

4. Qualifying circumstances

CPT 28292 is performed on patients with hallux valgus, a deformity where the first toe points towards the second toe, causing the foot to bump out to the side at the base of the first toe. The procedure is done to reduce symptoms, restore function, and correct the deformity. The specific qualifying circumstances depend on the underlying cause and the corrective method used by the provider.

5. When to use CPT code 28292

CPT code 28292 should be used when a provider performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base, using any method. It is important to accurately document the specific procedures performed during the surgery to support the use of this code.

6. Documentation requirements

To support a claim for CPT 28292, the provider must document the following information:

• Diagnosis of hallux valgus and the need for corrective surgery
• Details of the specific procedures performed, including the removal of the bony projection, resection of the proximal phalanx base, and sesamoidectomy
• Incision site and size
• Any additional procedures or techniques used
• Any complications or unexpected findings
• Post-operative care instructions
• Signature of the provider

7. Billing guidelines

When billing for CPT 28292, ensure that the documentation supports the use of this specific code. It is important to accurately report the procedures performed during the surgery. Review all codes in the range 28289 to 28299 to ensure the correct code is chosen. Additionally, consider any specific payer guidelines or requirements for reporting this code.

8. Historical information

CPT 28292 was added to the Current Procedural Terminology system on January 1, 1990. The code was later revised on January 1, 2017, to include the specific procedures performed during the surgery.

9. Examples

1. A patient undergoes a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using the McBride type procedure to correct their hallux valgus deformity.
2. A provider performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using a different method to correct a patient’s hallux valgus.
3. Using the Keller type procedure, a surgeon performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base to correct a patient’s hallux valgus.
4. A patient undergoes a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using the McBride type procedure to correct their hallux valgus deformity.
5. A provider performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using a different method to correct a patient’s hallux valgus.
6. Using the Keller type procedure, a surgeon performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base to correct a patient’s hallux valgus.
7. A patient undergoes a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using the McBride type procedure to correct their hallux valgus deformity.
8. A provider performs a bunionectomy with sesamoidectomy and resection of the proximal phalanx base using a different method to correct a patient’s hallux valgus.