The Austin and Akin procedures are the two most often performed bunionectomy procedures in the United States. Here are a few pointers to make sure you are coding them appropriately: If you need to record an Austin Bunionectomy operation, use the code 28296. This surgery consists of a metatarsal osteotomy that may be combined with or without a sesamoidectomy to achieve the desired results.
When to use CPT code 28292 and 28295
To report procedure code 28282, a bunionectomy should be performed to correct hallux valgus by removing the medial eminence of the metatarsal bone and resecting the base of the proximal phalanx. The base of the proximal phalanx is resected and two sesamoid bones located on either side of the metatarsal head may also be excised if they are fractured or inflamed.
This is generally done for mild deformities where there is very little deviation of the metatarsal.
28292 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method
To report procedure code 28295, a first metatarsal osteotomy is performed to correct hallux valgus in a bunionectomy procedure. The osteotomy site is proximal. It includes sesamoidectomy when performed. An osteotomy is performed when there is moderate metatarsus primus varus (deviation of the first metatarsal away from the other metatarsals) and the intermetatarsal angle is greater than 40 degrees.
28295 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method
Read also: When to use Gastrostomy tube placement CPT codes
“I have recently done bunionectomies on two separate patients with Anthem and received denials. One was a combination of an Austin procedure and an Akin procedure. I billed CPT 28299 -RT. On another patient, I did an Austin procedure and I billed CPT 28296 -RT. Both claims were denied for “inappropriate use of modifier.” I have called the customer service twice and even sent a corrected claim and removed the modifier but claim was still denied. Has something changed with Anthem that I don’t know about?”
When the corrected claims were resubmitted without an anatomical modifier appended to the CPT/procedure codes, I understand why reimbursement was not achieved based upon the fact that the claim lacked specificity. So, how should the claims be billed? Here is my suggestion: Procedure #1: CPT 28299 – T5 Procedure #2: CPT 28296 – T5
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Since bunionectomies/hallux valgus corrections are performed on the first metatarsal and the metatarsals are considered to be part of the foot, not part of the toe, you would think that the most appropriate anatomical modifier to append to a hallux valgus correction/bunionectomy that was performed on the right foot would be RT. Most health insurance companies with apparently very few exceptions agree with this premise. It appears that Anthem Blue Cross Blue Shield is one of the few that don’t. I don’t have a good explanation to support their decision to reject the hallux valgus correction/bunionectomy codes that were appended by the RT modifier, but they pay for the reimbursement so I guess this is the choice that they made.
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Repair, revision, and/or reconstruction procedures on the foot and toes are covered by CPT 28292, which is categorised as such. In accordance with the American Medical Association’s (AMA) Current Procedural Terminology (CPT) code 28292, a medical procedural code is assigned to procedures on the foot or toes that are repair, revision, and/or reconstruction procedures in nature.
FAQ
What is an Austin type bunionectomy?
What is included in CPT 28296?
What is included in CPT 28297?
What is included in CPT 28299?
