How To Use CPT Code 28295

CPT 28295 describes a specific procedure for the correction of hallux valgus, commonly known as a bunionectomy. This article will provide an overview of CPT code 28295, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28295?

CPT 28295 is a code used to describe a surgical procedure known as a bunionectomy. This procedure involves the removal of an enlarged bump, called a hallux valgus or bunion, on the side of the foot. Additionally, the surgeon may also perform a proximal metatarsal osteotomy, which involves making a cut into the foot bone closest to the big toe. This procedure aims to reduce symptoms, restore function, and correct the deformity caused by the bunion.

2. Official Description

The official description of CPT code 28295 is: ‘Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method.’

3. Procedure

1. The surgeon begins by making an incision in the foot over the target area.
2. They then deepen the incision to reach the first metatarsal head, which is the part of the metatarsal closest to where it meets the bone of the big toe.
3. Small vessels along the path are clamped and coagulated to minimize bleeding.
4. Specialized tools, such as an osteotome, mallet, or oscillating blade, are used to remove the enlarged bump of bone.
5. The surgeon may also remove the sesamoid bones, which are small bones located under the metatarsal head of the toe.
6. A proximal metatarsal osteotomy is performed, which involves completely transecting or creating a wedge incision into the bone closest to the big toe.
7. To ensure proper alignment, a rod, pin, or screw may be inserted to hold the remaining metatarsal and proximal phalanx in place.
8. The surgeon checks for bleeding and closes the incision.

4. Qualifying circumstances

CPT 28295 is used when a patient presents with a hallux valgus deformity, commonly known as a bunion, that requires surgical correction. The procedure may also involve a sesamoidectomy, which is the removal of a sesamoid bone located under the metatarsal head of the toe. It is important to note that the procedure must include a proximal metatarsal osteotomy, which is the cut made into the foot bone closest to the big toe. This code should only be used when all of these components are performed.

5. When to use CPT code 28295

CPT code 28295 should be used when a surgeon performs a bunionectomy with a proximal metatarsal osteotomy and, if necessary, a sesamoidectomy. It is important to ensure that all components of the procedure are performed in order to accurately report this code. If any of the components are not performed, a different code should be used to describe the specific procedure that was performed.

6. Documentation requirements

In order to support a claim for CPT code 28295, the surgeon must document the following information:

• Patient’s diagnosis of hallux valgus and the need for surgical correction
• Details of the procedure performed, including the proximal metatarsal osteotomy and sesamoidectomy, if applicable
• Date of the surgery
• Any additional procedures or techniques used during the surgery
• Any complications or unexpected findings during the surgery
• Post-operative care instructions and follow-up plans
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT code 28295, it is important to ensure that all components of the procedure are performed. This includes the bunionectomy, proximal metatarsal osteotomy, and sesamoidectomy, if applicable. It is also important to follow any specific guidelines provided by the payer regarding the use of this code. Additionally, it is important to note that CPT code 28295 should not be reported with other bunionectomy codes, as it is a specific code that describes the combination of procedures outlined in its official description.

8. Historical information

CPT code 28295 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with a severe hallux valgus deformity, and the surgeon performs a bunionectomy with a proximal metatarsal osteotomy and sesamoidectomy.
2. During the surgery, the surgeon discovers that the patient also has an inflamed sesamoid bone, which is causing pain. The surgeon performs a bunionectomy, proximal metatarsal osteotomy, and sesamoidectomy to correct the deformity and alleviate the pain.
3. A patient undergoes a bunionectomy with a proximal metatarsal osteotomy and sesamoidectomy on their left foot. The surgeon also performs a bunionectomy on the right foot, but no proximal metatarsal osteotomy or sesamoidectomy is necessary.