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v1.0.0
ICD-10 Guide
ICD-10 CodesM21.61

M21.61

Billable

Bunion

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M21.61 is a billable code used to indicate a diagnosis of bunion.

Key Diagnostic Point:

A bunion, clinically known as hallux valgus, is an acquired deformity characterized by a lateral deviation of the great toe (hallux) at the metatarsophalangeal joint. This condition often results from a combination of genetic predisposition, improper footwear, and biomechanical factors that lead to abnormal foot mechanics. The bunion manifests as a prominent bony bump on the inner side of the foot, which can cause pain, inflammation, and difficulty in wearing shoes. Over time, the misalignment can lead to secondary issues such as arthritis in the joint, calluses, and other toe deformities. Patients may experience varying degrees of discomfort, particularly during activities that involve pressure on the affected area. Treatment options range from conservative measures, such as orthotics and anti-inflammatory medications, to surgical interventions aimed at realigning the toe and alleviating pain. Corrective procedures may include osteotomy, exostectomy, or arthrodesis, depending on the severity of the deformity and the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of bunions
  • Need for detailed documentation of symptoms and treatment history
  • Potential for co-existing foot conditions that complicate coding
  • Variations in surgical procedures and their specific coding requirements

Audit Risk Factors

  • Inadequate documentation of the severity of the bunion
  • Failure to document conservative treatment measures prior to surgery
  • Incorrect coding of associated foot conditions
  • Lack of clarity in surgical procedure documentation

Specialty Focus

Medical Specialties

Podiatry

Documentation Requirements

Detailed history of foot pain, physical examination findings, and treatment history including conservative measures.

Common Clinical Scenarios

Patients presenting with foot pain, difficulty in shoe fitting, and visible deformity.

Billing Considerations

Ensure documentation reflects the severity of the bunion and any associated conditions.

Orthopedics

Documentation Requirements

Comprehensive assessment of foot mechanics, imaging studies, and treatment plans.

Common Clinical Scenarios

Patients requiring surgical intervention for severe bunions or associated deformities.

Billing Considerations

Document the rationale for surgical intervention and any pre-operative assessments.

Coding Guidelines

Inclusion Criteria

Use M21.61 When
  • According to the ICD
  • CM coding guidelines, M21
  • 61 should be used when the bunion is documented as hallux valgus
  • It is essential to include any relevant details regarding the severity and treatment history

Exclusion Criteria

Do NOT use M21.61 When
  • Exclusions include congenital bunions, which are coded differently

Related ICD-10 Codes

Related CPT Codes

28296CPT Code

Osteotomy, first metatarsal

Clinical Scenario

Performed for severe bunion correction.

Documentation Requirements

Document the surgical approach, pre-operative assessments, and post-operative care.

Specialty Considerations

Podiatrists and orthopedic surgeons should ensure clear documentation of the procedure and indications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of bunions, improving the accuracy of data collection and reimbursement processes. M21.61 provides a clear distinction for acquired bunions, enhancing clinical documentation and coding practices.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of bunions, improving the accuracy of data collection and reimbursement processes. M21.61 provides a clear distinction for acquired bunions, enhancing clinical documentation and coding practices.

Reimbursement & Billing Impact

reimbursement processes. M21.61 provides a clear distinction for acquired bunions, enhancing clinical documentation and coding practices.

Resources

Clinical References

  • •
    American Podiatric Medical Association

Coding & Billing References

  • •
    American Podiatric Medical Association

Frequently Asked Questions

What is the difference between M21.61 and M21.60?

M21.61 is used for documented cases of hallux valgus with specific details, while M21.60 is for unspecified cases where the details of the bunion are not provided.