CPT® Code 28290

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1. Indications

The procedure described by CPT® Code 28290 is indicated for the treatment of hallux valgus, commonly known as a bunion. This condition is characterized by a lateral deviation of the great toe, which can lead to pain, discomfort, and difficulty in wearing shoes. The following are specific indications for performing this procedure:

• Hallux Valgus Deformity - The primary indication for this procedure is the presence of a hallux valgus deformity that causes pain or functional impairment.
• Fractured Sesamoid Bones - The procedure may also be indicated if the sesamoid bones located adjacent to the metatarsal head are fractured or inflamed, contributing to the patient's symptoms.
• Failed Conservative Treatment - Patients who have not responded to conservative management options, such as orthotics, padding, or anti-inflammatory medications, may be candidates for surgical intervention.

2. Procedure

The procedure for CPT® Code 28290 involves several key steps that are performed to correct the hallux valgus deformity. Each step is crucial for ensuring the successful outcome of the surgery:

• Step 1: Incision - The surgical process begins with the creation of an incision over the medial aspect of the metatarsophalangeal joint. This incision allows the surgeon to access the underlying structures effectively.
• Step 2: Dissection - Following the incision, soft tissues are carefully dissected to expose the joint capsule. This step is essential for gaining access to the medial eminence of the metatarsal bone.
• Step 3: Joint Capsule Exposure - The joint capsule is incised to further expose the medial eminence. This exposure is critical for the subsequent excision of the bony prominence.
• Step 4: Excision of the Medial Eminence - The medial eminence is excised in line with the metatarsal shaft. This step is the core of the procedure, as it directly addresses the deformity causing the patient's symptoms.
• Step 5: Plication of the Joint Capsule - After the excision, the redundant joint capsule is plicated, which involves folding and suturing it to reduce excess tissue and promote healing.
• Step 6: Sesamoidectomy (if necessary) - If the sesamoid bones are found to be fractured or inflamed, a skin incision is made over the sesamoid bone, and the bone is excised following careful dissection of the surrounding soft tissues.
• Step 7: Closure - Finally, the incision is closed in layers to ensure proper healing and minimize scarring.

3. Post-Procedure

Post-procedure care following the correction of hallux valgus with CPT® Code 28290 typically involves monitoring for complications and managing pain. Patients are often advised to rest and elevate the foot to reduce swelling. Weight-bearing may be restricted for a period, and the use of a surgical shoe or boot may be recommended to protect the surgical site during the initial recovery phase. Follow-up appointments are essential to assess healing and ensure that the toe is aligning properly. Patients should be informed about signs of infection or complications that may require immediate medical attention.