Every autumn, the American Medical Association's (AMA) Current Procedural Terminology (CPT) book is updated with changes for the next year. In 2016, minimal changes were made, possibly due to the implementation of the International Classification of Diseases, 10th edition (ICD-10) and a desire to not overload physician practices. In a prior article, 2017 changes for the spine area were presented. (See "2017 Spine CPT Code Changes," AAOS Now, November 2016.) This column points out the CPT changes made for the foot and toes region.
In summary, effective Jan. 1, 2017, two new codes—28291 and 28295—have been established to report bunionectomy procedures, three codes—28290, 28293, and 28294—have been deleted, and six codes—28289, 28292, 28296, 28297, 28298, and 28299—have been revised.
The two new codes are defined as follows:
- 28291—Hallux rigidus correction with cheilectomy, débridement and capsular release of the first metatarsophalangeal joint; with implant
- 28295—Correction, hallux valgus (bunionectomy) with sesamoidectomy when performed; with proximal metatarsal osteotomy, any method
CPT code 28290 has been deleted, and a parenthetical note has been added to instruct users to report using code 28292. Code 28293 has also been deleted, and a parenthetical note added instructing users to use code 28291. Finally, CPT code 28294 has been deleted, and a parenthetical note added instructing users to report the unlisted code (28899).
The following CPT codes have been deleted, effective Jan. 1, 2017:
- 28290—Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (eg, Silver-type procedure)
- 28293—Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant
- 28294—Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon transplants (eg, Joplin-type procedure)
To summarize, effective Jan. 1, 2017:
- Instead of 28290, report procedure with 28292.
- Instead of 28293, report procedure with 28291.
- Instead of 28294, report procedure with 28899.
CPT codes 28289, 28292, 28296, 28297, 28298, and 28299 have been revised to remove legacy-named procedures for more accurate descriptions of the services as they are currently performed.
The bunionectomy code descriptors will no longer retain legacy-named procedures (eg, Keller-, McBride-, or Mayo-type procedure). Clinical practice, modifications to, and variations of the legacy-named procedures have evolved to the point that including the legacy names in the code descriptors is no longer appropriate or accurate.
As new methods were being developed, the legacy names became less important. Some surgeons were submitting the "new" procedures with the unlisted code 28899, which added administrative time to adjudicating charge submissions when it really wasn't necessary. Additionally, the phrase "without sesamoidectomy" has been removed from the descriptor.
The new descriptions for the modified codes are as follows (word changes are in italic):
- 28289—Hallux rigidus correction with cheilectomy, débridement and capsular release of the first metatarsophalangeal joint; without implant.
- 28292—Correction, hallux valgus (bunionectomy), with sesamoidectomy when performed; with resection of proximal phalanx base when performed, any method.
- 28296—Correction, hallux valgus (bunionectomy), with sesamoidectomy when performed; with distal metatarsal osteotomy, any method.
- 28297—Correction, hallux valgus (bunionectomy), with sesamoidectomy when performed; with metatarsal and medial cuneiform joint arthrodesis, any method.
- 28298—Correction, hallux valgus (bunionectomy), with sesamoidectomy when performed; with proximal phalanx osteotomy, any method.
- 28299—Correction, hallux valgus (bunionectomy), with sesamoidectomy when performed; with double osteotomy, any method.
All orthopaedic surgeons and their staffs should be aware that changes were also made to the work relative value units (wRVUs) for these codes (Table 1). This is important for surgeons who are compensated or reimbursed by a method that depends upon wRVUs. In part, these changes are due to shifts in practice patterns, which have led to fewer physician visits and less time associated with treating the patient. These changes were discussed at the AMA Specialty Society Relative Value Scale Update Committee or RUC. The Centers for Medicare & Medicaid Services has the final say in determining the wRVU for a specific CPT code.
As mentioned, all of the above changes went into effect on Jan. 1, 2017. The CPT codebook has diagrams depicting all of these surgical codes. It is advisable that orthopaedic surgeons work with their administrative and billing staffs to ensure that all of the changes to CPT are incorporated in their practice management system.
Michael R. Marks, MD, MBA, is an orthopaedic surgeon and consultant with KarenZupko & Associates, Inc. (KZA). The firm partners with AAOS to deliver annual regional coding workshops.