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05/08/2004    Michael Pasternac, DPM

Billing Multiple Procedures

Query: Billing Multiple Procedures

I have a 68 year old female patient with severe
rheumatoid arthritis of the right foot. I
performed a 1) pan-metatarsal head resection; 2)
Keller-type bunionectomy; and 3) proximal
interphalangeal joint arthroplasties 2-5. Are
these billed separately, or are there codes that
bundle them together?

Michael Pasternac, DPM
Miami, FL

Codingline response: Each of these procedures is
payable separately.
I would code the surgery as follows:

CPT 28292-RT (correction, hallux valgus
(bunion), with or without sesamoidectomy; Keller-
CPT 28285-T6 (hammertoe correction 2nd right)
CPT 28285-T7 (hammertoe correction 3rd right)
CPT 28285-T8 (hammertoe correction 4th right)
CPT 28285-T9 (hammertoe correction 5th right)
CPT 28112-59 (ostectomy, complete excision; 2nd
metatarsal head)
CPT 28112-59 (ostectomy, complete excision; 3rd
metatarsal head)
CPT 28112-59 (ostectomy, complete excision; 4th
metatarsal head)
CPT 28113-59 (ostectomy, complete excision; 5th
metatarsal head)

I would not consolidate the last 4 met head
resections into CPT 28114 because CPT 28114
definition includes partial proximal
phalangectomies (i.e., bases of the proximal
phalanges) which were not performed according to
your example.

I would need a clarification as to whether you
included the first metatarsal head in your
description of "pan-metatarsal head resection."
If you did, then you would also bill CPT 28111.

Tony Poggio, DPM
Alameda, CA

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