Procedure Practice 11/15/97

Listed below are the ICD-9-CM diagnosis and procedure codes as well as the CPT-4 procedure codes that we think properly classify this episode of treatment. Please note that modifiers, used only for physician billing purposes, have not been assigned to the CPT-4 codes.

Procedures

Modified McBride bunionectomy, joint fixation
   

Codes and Rationale

The surgeon performed a fairly conservative procedure to correct the patient’s bunion deformity. No bone other than the exostosis was removed. Therefore the procedure focused on soft tissue repair to correct the valgus position of the toe. However, the surgeon did find it necessary to internally fixate the MTP joint in order to keep the toe in alignment. In the ICD-9-CM procedure index we are referred to 77.5 as the main heading for all bunion repairs. The selection of the correct code is fairly straightforward in this case. Code 77.52, bunionectomy with soft tissue correction and arthrodesis, accurately reflects the surgery performed. No additional code is needed for the ligament release, as it is included in the soft tissue repair.

The correct CPT code assignment is not as straightforward, but careful review of the procedures done will point us in the right direction. We can eliminate all bunion repair codes that involve any bone excisions other than the medial exostosis. We can also eliminate any procedures involving osteotomies; the surgeon did not divide or cut into any normal bone tissue. That leaves us with two codes to select from, 28290 and 28292. It is obvious from the operative note that 28290 does not capture all the components of the procedure performed. Now it becomes clearer that 28292 is the correct code. This code includes all the main components of the procedure: the excision of the exostosis, the ligamentous repair and tightening of the joint capsule, and the use of a pin to stabilize the repair.