Hallux valgus (bunion) is a common forefoot deformity, which typically comprised of a bony prominence at the distal metaphysis (head) of the first metatarsal, lateral deviation of the great toe (hallux) at the first metatarsophalangeal joint, and valgus rotation of the hallux. 

A bunion is simple the prominence over the first metatarsal. This can be on the side or top of the foot, or both.

Sesamoids are in the flexor tendons on the bottom of the foot. As the metatarsal head moves away from the second metatarsal, the sesamoids are no longer located under the metatarsal head, further causing deviation of the toe and the metatarsal. As a result, the joint capsule on the medial of the foot stretches and the lateral side tightens up. As the condition progresses, the tendons contract and cause further deviation of the toe and the metatarsal.

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Coding rules for Bunionectomy CPT codes

A bunionectomy is a surgical procedure to excise, or remove, a bunion. The majority of bunionectomy procedures are performed to correct the deviation of the metatarsal. When correcting that deformity, the valgus deformity of the often corrects without the need for additional surgery, such as an osteotomy of the phalanx.

Their are many CPT codes added and revised in this section. CPT code 28292, 28296, 28295, 28297, 28298 & 29299 are used for coding bunionectomy. 

Their are many small and minor procedures are included in the bunionectomy. Minor procedures included in Bunionectomy are:

• Removal of the bony prominence (bunion)
• Removal of additional osteophytes
• Arthrotomy
• Capsulotomy
• Tenotomy
• Tendon release
• Tenolysis
• Placement of internal fixation
• Removal of bursal tissue
• Articular shaving at the first metatarsophalangeal joint

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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

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When to report CPT code 28296 & 28297

CPT 28296 is reported to correct a hallux valgus deformity with a distal metatarsal osteotomy. The procedure includes sesamoid bone removal, when necessary, to help with bone realignment. This type of correction is done for patients with mild hallux valgus of less than 40 degrees and a minimal increase in the deviation of the metatarsal.

28296 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method

For coding cpt code 28297, a  bunionectomy involving excision of the medial eminence, tenotomy, and joint fusion of the first metatarsal bone to the first cuneiform bone is performed to correct hallux valgus.  The fusion may be done with sesamoid bone removal, when necessary. This type of correction is done for a severe intermetatarsal angle or instability of the first tarsometatarsal joint.

28297 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method

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When to use CPT code 28298 & 28299

To report CPT code 28298, a proximal phalanx osteotomy  is performed to correct hallux valgus in a bunionectomy procedure. This procedure may be performed with sesamoid bone removal, when necessary, to help with bone realignment.

28298 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method

To report CPT code 28299 ,  two or double osteotomy procedures are done to straighten the toe and the metatarsal. These procedure may be done along with sesamoid bone removal, when necessary, to help with realignment. The double osteotomy can be a combination of an osteotomy of the phalanx and the metatarsal (proximal or distal) or a proximal and distal metatarsal osteotomy.

28299 –  Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method

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