Recurrent Ganglion excision 28090

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I have a op note that I am trying to figure out how to code, this patient had a ganglion removed and we billed that as 28090 but with the recurrent one my coworker doesn't think that same code works this time around. Would you bill it as 28090 or what my coworker was thinking(28039)? Anytime a ganglion is excised do you automatically use the ganglion excision code or can we use the mass excision code? I was thinking 28090 because the description states "removed from the tissue surrounding the tendon" and this op note states that it was near the tendon sheath but not attached to it.
 

podcoder70

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A ganglion cyst is just that, whether being removed for the first time, second or third. They often grow back. I will assume that in this scenario the patient was outside of the global period for the first excision and the surgeon is identifying it as a ganglion. The code is 28090 for the foot and 28092 for the toe. To use the code 28039 would not be appropriate because there is a more specific code available.
 
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A ganglion cyst is just that, whether being removed for the first time, second or third. They often grow back. I will assume that in this scenario the patient was outside of the global period for the first excision and the surgeon is identifying it as a ganglion. The code is 28090 for the foot and 28092 for the toe. To use the code 28039 would not be appropriate because there is a more specific code available.
Yes, this was outside of a global but my question is that the note states it wasn't attached to the tendon sheath, tendon or capsule. It was removed from the tissue surrounding the tendon sheath. Can you bill 28090 when it was removed from the tissue surrounding it? Do you have any specific information that helps answer this question?
 

podcoder70

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Rachel, the coding completely depends on the documentation. If the doctor documented that it is a "ganglion" then you would code as such. If you feel the description more closely matches "soft tissue mass", you might want to ask the doctor what he/she thinks and perhaps the documentation or diagnosis needs to be amended.
 
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Rachel, the coding completely depends on the documentation. If the doctor documented that it is a "ganglion" then you would code as such. If you feel the description more closely matches "soft tissue mass", you might want to ask the doctor what he/she thinks and perhaps the documentation or diagnosis needs to be amended.
The doctor has documented that it is a ganglion, would you bill it as 28090 Excision of lesion, tendon, tendon sheath, or capsule. The lay description states that the benign ganglion is excised or removed from the tissue surrounding the tendon. The ganglion from my op note was removed from the tissue surrounding it, it was not attached to or in the tendon/tendon sheath/capsule so would 28090 support removing the ganglion from the tissue surrounding it?
 

podcoder70

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The code is described as Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot.
Notice the "OR" in the description? So, yes, the 28090 would be appropriate for the excision of a ganglion on the tissue surrounding the tendon.
 
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Location
Delaware, IA
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The code is described as Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot.
Notice the "OR" in the description? So, yes, the 28090 would be appropriate for the excision of a ganglion on the tissue surrounding the tendon.
Thank you. That is what I was thinking but my coworker was thinking the other way so just wanted to get some more opinions.
 
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