UASI Coding Passport

Podiatric medicine is a branch of medicine devoted to the study, diagnosis, and medical and surgical treatment of disorders of the foot , ankle, and lower extremity. Each foot contains 28 bones to include three main parts: tarsals, metatarsals, and phalanges. Most of the common feet-related procedures are located in the code series (28001- 28899) of the CPT Manual. The tarsals are the seven bones that form the ankle. The metatarsals are the five bones that are located between the ankle and the toes. The phalanges are the 14 bones that form the toes.

Common podiatry procedures and codes

Hallux valgus corrections (28292- 28299)
Hallux valgus corrections are also known as bunionectomies of the great toe. The CPT codes for this procedure are located within the (28292-28299) series. A bunion is a medial protrusion of the distal end of the first metatarsal and lateral deviation of the great toe. Correction procedures vary in method and may include osteotomies or the insertion of implants, screws, or wire. “To select the correct code, coders must look closely at which bones are being altered and Identify where the physician is making the incision and where the screws are being placed.”¹

CPT Code 28295 correction of hallux valgus with sesamoidectomy with proximal metatarsal osteotomy and CPT code 28298 correction of valgus hallux with sesamoidectomy with proximal phalanx osteotomy both describe bunionectomies that include osteotomy; however, CPT 28295 is reported for procedures that include the proximal metatarsal while CPT code 28298 is coded for those that include the proximal phalanx.

Eponyms for hallux valgus correction procedures include Akin osteotomy which is described by CPT code 28292 (correction, hallux valgus, with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method). “The scarf and chevron are two other terms for bunionectomy procedures whose descriptions fall under CPT code 28296 (correction, hallux valgus, with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method).”²

Tailor’s bunion is a deformity of the fifth toe. A partial excision of the fifth metatarsal (28110) is typically performed to correct this deformity. When this procedure is performed alongside a bunionectomy, modifier 59 or XS is applied as it requires an additional incision on a separate anatomical structure.

Other podiatric diagnoses and procedures

Hammertoe is an abnormal bend of the middle phalangeal joint of the toe. Hammertoe correction procedures include interphalangeal fusion, partial or total phalangectomy. (see CPT code 28285).

Cock-up fifth toe is when the MTP joint of the smallest toe is dislocated or subluxated. The correction is reported with CPT code 28286, an incision is made under the fifth toe and the soft tissues are reflected to expose the proximal phalanx which is then removed leaving a space between the base of the metatarsal and the distal phalanx. The deep tissues and skin incisions are closed with sutures.

Arthrodesis is performed to prevent the mobility of bones and to stabilize hyperflexible or weak joints. CPT codes 28705-28760 are reported depending on the number of bones involved and/or if tendons are lengthened or metatarsals are fused to phalanges.

Do not forget to apply modifiers to identify which foot right (Rt) or left (Lt) for foot procedures and modifiers TA and T1 through T9 to identify procedures on toe digits.

^{1, 2 Savannah Schmidt, Clarify CPT coding for podiatric repair and reconstruction procedures, Just Coding May 4, 2022}

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