bunionectomy

How would you code a combo Lapidus with Chevron bunionectomy? I wanted to code 28297 with 28306-59 but I'm not certain.

re: bunionectomy

Lapidus type procedure This procedure is a distal soft tissue rearrangement and a proximal first metatarsal cunieform arthrodesis. AAOS states that this procedure includes: arthrotomy, tendon transfer or release, synovectomy, capsular release and/or reconstruction, removal of additional exostoses in the area of the joint, internal fixation, removal of bursal tissue, repair of released tendon, arthrodesis, tarsometatarsal joint, local bone graft, proximal first metatarsal osteotomy and allows additional coding and report for: phalangeal osteotomy to correct deformity, harvesting and insertion of bone graft from distant site (separate skin or fascial incision) and ankle tendon lengthening. 28297.

28296 - ; with metatarsal osteotomy (e.g. Mitchell, Chevron or concentric type procedures) This procedure includes a distal metatarsal osteotomy. AAOS states that this procedure includes: arthrotomy, synovial biopsy, tendon release or transfer, synovectomy, capsular release and reconstruction, removal of additional exostoses in the area of the joint, internal fixation, articular shaving, arthroscopy, removal of bursal tissue, repair of released tendon, implant insertion, local bone graft and allows additional coding and report for: phalangeal osteotomy to correct deformity, harvesting and insertion of bone graft from distant site (separate skin or fascial incision), and ankle tendon lengthening.

Check documentation, if both separate and medically necessary code 28296 with -59.