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Modified Lapidus ASC Billing

Camille Posted Thu 09th of January, 2020 17:11:54 PM
When a provider performs a Modified Lapidus, but does a 2nd osteotomy I need to code 28299 instead of 28297. Is that correct? I'm confused because I understand Medicare has placed CPT 28299 in a lower APC Grouper than 28297 and 28298. i think the work is greater in most cases and warrants at least the reimbursement of 28297 and 28298. Will you please correct me or clarify this? Thank you very much!
SuperCoder Answered Fri 10th of January, 2020 08:50:04 AM

Hello Camille,

Thank you for your question


If correction of hallux valgus was performed through double osteotomy and sesamoidectomy, the appropriate CPT® code would be 28299. However, if the joint arthrodesis was also performed on the day of procedure, appropriate CPT® code would be 28297. We suggest you to append modifier 22 (for double osteotomy part of the procedure) with CPT® code 28297, as it will guarantee you the extra reimbursement in addition to the dollar value of code 28297 ($4020.63) in ASC setting.


If we would use CPT® code 28299 for double osteotomy, it would not cover the arthrodesis part. Also, reimbursement for the said code in ASC setting is very less ($2803.36) than the suggested code (i.e. 28297).


Hence, it will be appropriate to report code 28297.


Hope that helps!


Camille Posted Fri 10th of January, 2020 11:47:28 AM
Very helpful! Thank you, again!
Camille Posted Fri 10th of January, 2020 11:55:59 AM
Since Modifier -22 is not used in the ASC billing; in the above scenario, is there any way I can code for the additional osteotomy such as: 28297-RT and 28299-52-RT? Thanks very much!
SuperCoder Answered Mon 13th of January, 2020 06:59:21 AM

Hello Camille,

Thank you for your additional question.


Since, your procedure (modified Lapidus) was performed on the right side, so reporting separately for osteotomy on the same anatomical site will not be appropriate. In order to report 28299 for right side separately, your detailed operative note should indicate the separate anatomical location for osteotomy other than the Lapidus procedure.


Also appending modifier 52 with 28299 for osteotomy when performed with modified Lapidus procedure will not be appropriate, since, the CPT® code 28297 includes the part of removal of the bone.


Hope that helps!


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