CPT® Code 28294

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1. Indications

The procedure described by CPT® Code 28294 is indicated for the treatment of hallux valgus, particularly in cases where the deformity is causing significant pain or functional impairment. The following conditions may warrant this surgical intervention:

• Hallux Valgus Deformity The primary indication for this procedure is the presence of a bunion, characterized by the lateral deviation of the great toe and associated soft tissue swelling.
• Sesamoid Bone Issues The procedure may also be indicated if the sesamoid bones are fractured or inflamed, necessitating their removal to alleviate pain and restore function.
• Functional Impairment Patients experiencing difficulty in walking or performing daily activities due to the bunion deformity may require this corrective surgery.
• Failure of Conservative Treatments Prior non-surgical treatments, such as orthotics, physical therapy, or anti-inflammatory medications, have proven ineffective in managing symptoms.

2. Procedure

The surgical procedure for CPT® Code 28294 involves several detailed steps to correct the hallux valgus deformity and may include tendon transplantation. The following outlines the procedural steps:

• Dorsal Incision A dorsal incision is made over the metatarsophalangeal joint to provide access to the underlying structures. This incision allows the surgeon to visualize and manipulate the joint effectively.
• Dissection of Soft Tissues The soft tissues surrounding the joint are carefully dissected to expose the joint capsule. This step is crucial for accessing the joint and the associated anatomical structures.
• Incision of the Joint Capsule The joint capsule is incised to reveal the medial eminence, which is the bony prominence on the inner side of the metatarsal head. This exposure is necessary for the subsequent excision of the medial eminence.
• Excision of the Medial Eminence The medial eminence is excised in alignment with the metatarsal shaft. This step helps to correct the deformity by removing the bony prominence that contributes to the bunion.
• Excision of Articular Cartilage and Bone Articular cartilage and any hypertrophic bone are excised from both the proximal phalangeal base and the metatarsal head to prepare the joint surfaces for fusion.
• Release of the Extensor Tendon The extensor tendon is released from the base of the distal phalanx, allowing for its subsequent transplantation to the metatarsal head.
• Fusion of Bones The proximal phalanx and metatarsal bones are fused together to stabilize the joint and restore proper alignment of the toe.
• Transplantation of the Extensor Tendon The extensor tendon is then transplanted to the head of the metatarsal bone, which is essential for restoring function and movement of the great toe.
• Plication and Closure of the Joint Capsule The joint capsule is plicated to secure the joint in its new position, and then it is closed to promote healing.
• Sesamoid Bone Excision (if necessary) If the sesamoid bones are fractured or inflamed, a skin incision is made over the sesamoid bone, and the soft tissues are dissected around it for excision. The soft tissue and skin are then closed in layers to complete the procedure.

3. Post-Procedure

After the completion of the procedure, patients can expect a recovery period that may involve pain management and rehabilitation. Post-operative care typically includes monitoring for any signs of infection, managing swelling, and ensuring proper alignment of the toe. Patients may be advised to limit weight-bearing activities for a specified duration to allow for healing. Follow-up appointments are essential to assess the surgical site, evaluate the healing process, and determine when physical therapy or gradual return to normal activities can begin. The overall goal of post-procedure care is to ensure optimal recovery and restore function to the affected toe.