Summary & Overview
CPT 28296: Bunion Correction with Distal Metatarsal Osteotomy
CPT code 28296 represents surgical correction of a bunion through a distal metatarsal osteotomy, often including removal of sesamoid bones. This code is used to bill for operative treatment of hallux valgus deformity that produces a symptomatic bony prominence at the first metatarsophalangeal joint. Nationally, procedures for bunion correction are common in orthopedic and podiatric practice and have implications for surgical utilization, coding consistency, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, typical sites of service (hospital outpatient departments and ambulatory surgery centers), and service line classification as foot/forefoot orthopedic surgery.
Readers will learn: the clinical scope of CPT code 28296, how it is positioned relative to related foot procedures, common billing considerations, and the types of benchmarks and policy topics typically relevant to payer coverage and reimbursement discussions. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes are noted where applicable.
Billing Code Overview
CPT code 28296 describes a surgical procedure to remove bone from a bunion deformity at the base of the big toe. The procedure includes a distal metatarsal osteotomy, which involves cutting and realigning the long bone of the foot, and may include removal of the sesamoid bones beneath the great toe joint.
Service Type: Surgical — Foot/Forefoot Orthopedic Procedure
Typical Site of Service: Hospital outpatient department or ambulatory surgery center
Data not available in the input for associated taxonomies and ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A 56-year-old ambulatory female presents with progressive pain and deformity of the right first metatarsophalangeal joint consistent with a symptomatic hallux valgus (bunion). Conservative measures including wider footwear, orthotics, and NSAIDs failed over 12 months. On exam she has a painful medial eminence, dorsomedial bursitis, and a hallux valgus angle indicating distal metatarsal malalignment. Preoperative evaluation includes weight-bearing foot radiographs, history and physical, and anesthesia clearance. The patient undergoes operative distal metatarsal osteotomy with removal of the bony prominence and possible excision of hypertrophic sesamoids. Procedure is performed in an ambulatory surgery center under regional block with monitored anesthesia care. Postoperative workflow includes dressing application, postoperative weight-bearing instructions, analgesics, and follow-up at 2 weeks for wound check and at 6–8 weeks with repeat radiographs to assess osteotomy healing and alignment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | Use when procedure is performed on the right foot |
LT | Left side | Use when procedure is performed on the left foot |