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v1.0.0
ICD-10 Guide
ICD-10 CodesM21.611

M21.611

Billable

Bunion of right foot

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

Code Description

ICD-10 M21.611 is a billable code used to indicate a diagnosis of bunion of right foot.

Key Diagnostic Point:

A bunion, or hallux valgus, is a common foot deformity characterized by a lateral deviation of the great toe (hallux) at the metatarsophalangeal joint, leading to a prominent bony bump on the inner side of the foot. This acquired deformity often results from a combination of genetic predisposition, inappropriate footwear, and biomechanical factors. The condition can cause pain, swelling, and inflammation, particularly when pressure is applied to the bunion area. Patients may experience difficulty in wearing shoes, leading to a decreased quality of life. Over time, the misalignment can lead to secondary issues such as arthritis in the affected joint, metatarsalgia, and other toe deformities. Treatment options range from conservative measures, such as orthotics and padding, to surgical interventions aimed at realigning the toe and alleviating pain. Surgical 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

  • Differentiating between primary and secondary bunions
  • Understanding the severity of the deformity
  • Identifying associated conditions (e.g., arthritis)
  • Documentation of conservative vs. surgical treatment plans

Audit Risk Factors

  • Inadequate documentation of the deformity's severity
  • Failure to document conservative treatment attempts
  • Misclassification of the condition as a primary diagnosis
  • Lack of clarity on associated conditions or complications

Specialty Focus

Medical Specialties

Podiatry

Documentation Requirements

Detailed clinical notes on the patient's history, physical examination findings, and treatment plans.

Common Clinical Scenarios

Patients presenting with foot pain, difficulty in shoe fitting, or referral for surgical evaluation.

Billing Considerations

Ensure clear documentation of conservative management prior to surgical intervention.

Orthopedics

Documentation Requirements

Comprehensive assessment of foot structure, alignment, and any associated deformities.

Common Clinical Scenarios

Patients with advanced bunion deformities requiring surgical correction or those with associated joint issues.

Billing Considerations

Document any pre-existing conditions that may affect surgical outcomes.

Coding Guidelines

Inclusion Criteria

Use M21.611 When
  • According to ICD
  • 10 coding guidelines, M21
  • 611 should be used when the bunion is specifically located on the right foot
  • Coders must ensure that the diagnosis is supported by clinical documentation, including the patient's symptoms and any treatment provided

Exclusion Criteria

Do NOT use M21.611 When
  • Exclusion criteria include congenital deformities and bunions resulting from systemic conditions

Related ICD-10 Codes

Related CPT Codes

28296CPT Code

Bunionectomy

Clinical Scenario

Performed when conservative treatments fail and the bunion causes significant pain.

Documentation Requirements

Pre-operative assessment, surgical notes, and post-operative follow-up.

Specialty Considerations

Podiatrists and orthopedic surgeons must document the rationale for surgery.

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. M21.611 provides clarity on the affected side, which is crucial for treatment planning and outcomes assessment.

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. M21.611 provides clarity on the affected side, which is crucial for treatment planning and outcomes assessment.

Reimbursement & Billing Impact

reimbursement processes. M21.611 provides clarity on the affected side, which is crucial for treatment planning and outcomes assessment.

Resources

Clinical References

  • •
    American Podiatric Medical Association
  • •
    American Academy of Orthopaedic Surgeons

Coding & Billing References

  • •
    American Podiatric Medical Association
  • •
    American Academy of Orthopaedic Surgeons

Frequently Asked Questions

What is the primary cause of bunions?

Bunions are primarily caused by a combination of genetic factors, improper footwear, and biomechanical issues that lead to the misalignment of the big toe.

How can bunions be treated?

Treatment options for bunions include conservative measures such as shoe modifications and orthotics, as well as surgical procedures for severe cases.