APMA News - May/June 2023 - 33

coding update
includes the removal of prominent or hypertrophied
bone from the medial aspect of the first
metatarsal head. "
More support for this guidance can be found in
the AMA Relative Value Scale Update Committee
(RUC)3
capsulotomy of the lateral aspect of the first metatarsophalangeal
joint. The CPT code representing
this capsulotomy is:
database. The clinical vignettes listed in the
AMA RUC database include all steps typically associated
with a CPT code. The intra-service portion
of the clinical vignette for CPT 28297 described
in the AMA RUC database includes the following
sentence: " The medial eminence is excised. "
Considering the above guidance from the AMA,
when a first metatarsocuneiform joint arthrodesis is
performed by any method without resection of the
medial eminence of the first metatarsal head, the
appropriate CPT code is CPT 28740. When a first
metatarsocuneiform joint arthrodesis is performed
by any method in combination with resection of
the medial eminence of the first metatarsal head
(i.e., with bunionectomy), the appropriate CPT
code is CPT 28297.
Provider Education
Many surgeons consider a first metatarsocuneiform
joint arthrodesis procedure that results in
correction of an elevated first intermetatarsal
angle, reduction of an elevated hallux valgus
angle, and the patient no longer having a bony
prominence of the medial forefoot to be a
" bunionectomy " procedure. Clinically speaking,
this description is correct. However, what
these surgeons accept as the clinical definition
of " bunionectomy " is not the same as the CPT
Editorial Panel's definition of " bunionectomy. "
Clinically speaking, most surgeons feel a " bunionectomy "
procedure has been performed in the
absence of resection of the medial eminence of
the first metatarsal head if the procedure results
in reduction of the first intermetatarsal angle,
reduction of an elevated hallux valgus angle, and
elimination of bony prominence of the medial
forefoot. However, when it comes to CPT coding,
a " bunionectomy " CPT code cannot be used
without resection of the medial eminence of the
first metatarsal head. It is important to understand
this difference between the CPT Editorial
Panel definition of " bunionectomy " and most
providers' definition of " bunionectomy. "
Combining First Metatarsocuneiform
Joint Arthrodesis With First
MPJ Capsulotomy
Oftentimes a first metatarsocuneiform joint
arthrodesis procedure is combined with a
CPT 28270 - Capsulotomy; metatarsophalangeal
joint, with or without tenorrhaphy, each joint (separate
procedure)
When these two procedures are both performed
in the absence of resection of the medial eminence
of the first metatarsal head, it is appropriate to submit
both CPT 28740 and CPT 28270.
Direction regarding coding for multiple
procedures at the same encounter is provided
by the National Correct Coding Initiative
(NCCI).4
The NCCI publishes procedure-toprocedure
(PTP) edits for certain CPT code
combinations. These edits are usually based
upon the standards of medical/surgical
practice.4
When one service is considered to
be an integral component of another service,
the CPT codes that represent the two services
are paired by an NCCI PTP edit. In general,
when a pair of services is provided at the same
encounter whose CPT codes are paired by an
NCCI PTP edit, both CPT codes should not be
reported unless it is clinically appropriate to use
an NCCI PTP-associated modifier.
The NCCI procedure-to-procedure edits do not
pair CPT 28740 and CPT 28270.
Conclusion
Providers must consider the AMA CPT Editorial
Panel's definition of " bunionectomy " when coding
for first ray procedures. CPT coding convention
does not allow for any approximation of services
performed in code selection.
Endnotes
1
2023 CPT Professional Current Procedural
Terminology (CPT®) is copyright 1966, 1970,
1973, 1977, 1981, 1983-2022 by the American
Medical Association. All rights reserved. CPT is
a registered trademark of the American Medical
Association (AMA).
2
American Medical Association Resourcebased
Relative Value Scale Update
Committee https://www.ama-assn.org/about/
rvs-update-committee-ruc
4
https://www.cms.gov/Medicare/Coding/
NationalCorrectCodInitEd/Downloads/nccicorrespondence-language-manual.pdf
APMA.ORG
apmanews
33
CPT
Assistant Online https://ocm.ama-assn.org/
OCM/CPTAA/Overview.do
3

https://ocm.ama-assn.org/ocm/cptaa/overview.do https://ocm.ama-assn.org/ocm/cptaa/overview.do https://www.ama-assn.org/about/rvs-update-committee-ruc https://www.ama-assn.org/about/rvs-update-committee-ruc https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/ncci-correspondence-language-manual.pdf https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/ncci-correspondence-language-manual.pdf https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/ncci-correspondence-language-manual.pdf http://www.APMA.ORG

APMA News - May/June 2023

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