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Exostosis confusion and podiatry coding confusion

  1. Default
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    Quote Originally Posted by BFAITHFUL View Post
    I'm sorry...I can't really do that.. because I only know that TCN states this because if you go to their website they have sample audit reports and in their sample audit reports that what is says about the AMA but I have yet to see such article with my own eyes. I am going to send in my question to the AMA directly and once I receive their response I will get back to you. I have done this in the past where I am really confused about a CPT code.
    I am curious if you ever got a response from the AMA reagarding the use of 28122 vs. 28104?


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    BFaithful - if you're out there - did you ever hear anything back about this?

    I'm still wondering also, Liz. I still haven't found (from the AMA or anyone else) anything to substantiate the audit decision made by the TCN sample audit about the exostosis (see past entries.) I'm still going with what other podiatry coders have told me - an exostosis is not a 'cyst' per se ('cyst' implies fluid filled or blood filled....not solid bone), it's an overgrowth of bone, so 'partial excision (bossing, etc.) of bone' better defines it - the 28122 for metatarsal. 2012 CPT still refers you to 'use benign cyst code 27635 for exostosis' in the leg and ankle....but no such line referencing you to do this in the foot area. Confusing at best.

    Please post if you find any answers - thank you.

  3. Default Per CPT ASST
    MAY 2011 CPT ASST


    Musculoskeletal System


    The patient was diagnosed with retrocalcaneal bursitis and Haglund's deformity of calcaneus. An inci-sion was made along the lateral aspect of the distal Achilles tendon and the tendon was reflected thereby expos-ing the calcaneus. The retrocalcaneal bursa was excised. Next, an osteotome was used to remove the Haglund's deformity down to the Achilles insertion. A rasp was used to ensure that there were no residual osseous spurs. Debridement of the necrotic area of the Achilles tendon was performed, and the incision was closed in layers with sutures. Is it appropriate to report CPT code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, for this procedure?


    No. If a Haglund's deformity of the heel and retrocalcaneal bursa were removed, then code 28118, Ostectomy, calcaneus, should be reported. If additional work other than for exposure was performed on the Achil-les tendon, then that service would be reported as 28200, Repair, tendon, flexor, foot; primary or secondary, with-out free graft, each tendon. If there is a spur on the bottom of the foot and a plantar fascial release is performed, then code 28119, Ostectomy, calcaneus; for spur, with or without plantar fascial release, would be reported in-stead of/in addition to 28118. Code 28120, Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus, is typically performed for an infection and not for an exostosis, and only if a partial excision of the heel is performed.

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    Hello all, I inquired about the exostosis coding with Mr. Paul Cadorette of MD Strategies. He clarified that the notes under CPT 27640 and 27641 that direct you to 27635-Excision or curettage of bone cyst or benign tumor, also applies to other anatomical areas such as the foot.
    Last edited by bethh05; 03-27-2012 at 01:00 PM.

  5. Default
    Beth, If you speak with him again, could you ask - or maybe you know the answer to this - where is the documentation - from CPT or AMA, etc, - that specifies guidelines in one anatomical area should be followed in others? Coders I've talked to say not to do that.

    But the only 'documentation' we have so far seems to point to the same conclusion - the CPT Assistant reference that Jamie added (above) says 28120 (partial excision of bone) 'typically is performed for an infection and not for an exostosis' ....

  6. Default most current query
    AMA Question
    Date: 03/30/2012




    A parenthetical note under code 27640 states, “For exostosis excision, use 27635” (Excision or curettage of bone cyst or benign tumor, tibia or fibula). Can it be inferred that these codes may be used for any excision of exostosis or does the surgeon have to have docu-mented that the patient had a bone cyst or benign tumor?


    An exostosis is a benign tumor; therefore, it is appropriate to report code 27635, Excision or curettage of bone cyst or benign tumor, tibia or fibula.

  7. Default
    Thank you for that update. I never would have defined 'exostosis' as being a 'benign tumor' ..... but there it is !

  8. #18
    Springfield, Mo
    Default exostosis, again
    Picking up an old thread here... It looks like AAOS recommends coding 28120-28124 for exostosis removal. I am wondering if payers tend to agree? If there is someone out there who codes it that way... could you share your experience with that, please?
    Last edited by solocoder; 01-30-2015 at 04:57 AM.
    solocoder CPC

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