CPC, COC, CPC-P, COSC, CASCC
Director of Education for mdStrategies
Previously we reported 28293 when a hemi- or total joint arthroplasty was performed at the first metatarsophalangeal joint but that code was deleted in 2017 and replaced with 28291 – Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant. Even though the CPT code changed, the guidelines that apply to this code have not.
28291 is only reported for arthroplasty procedures of the “first” MTPJ
This code is not reported for MTPJ’s 2-5
This code is not reported for interphalangeal joint procedures
One thing that has changed is that the AMA has loosely applied the term “with implants”. Not only does this code allow for reporting of the hemi- and total arthroplasty implants but basically any other type of implant placed in the joint space such as Cartiva (synthetic cartilage plug) or Arthrosurface Hemi-cap implants which are not joint replacement implants.
Although it is appropriate to report 28291 for a myriad number of devices you still need to take into consideration you carrier’s policy guidelines. Many of the arthroplasty implants are considered experimental/investigational and not covered by the patient’s policy. I found very little information relating to Cartiva and Arthrosurface implants but if you review Aetna policy #0661 you will see that toe joint “resurfacing” is considered experimental/investigational. Use of the Classic Hemi-Cap toe implant is a resurfacing procedure.
The issue here is not whether or not you can report 28291 because in most instances you can, but whether or not the device being implanted is an approved device based on the patient’s insurance plan.