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What would you do?

  1. Question What would you do?
    Medical Coding Books
    Can anyone tell me how they would code this and why did you selected the codes you chose? I would really appreciate it. I am sincerely grateful.

    A longitudinal incision was then made about 3 cm in length centering over this point on the dorsal aspect of the foot. The area was taken down through subcutaneous tissue with bleeders clamped and Bovied in the usual manner. Careful dissection was then performed to expose the area of the exostosis. An arthrotomy of the talo-navicular joint was performed to expose the exostosis and insure no lose bodies were present in joint. This was done without difficulty. Of note no evidence of significant arthritis was found. Having done this, using a osteotome the exostosis was removed.

  2. #2
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    Quote Originally Posted by coders_rock! View Post
    Can anyone tell me how they would code this and why did you selected the codes you chose? I would really appreciate it. I am sincerely grateful.

    A longitudinal incision was then made about 3 cm in length centering over this point on the dorsal aspect of the foot. The area was taken down through subcutaneous tissue with bleeders clamped and Bovied in the usual manner. Careful dissection was then performed to expose the area of the exostosis. An arthrotomy of the talo-navicular joint was performed to expose the exostosis and insure no lose bodies were present in joint. This was done without difficulty. Of note no evidence of significant arthritis was found. Having done this, using a osteotome the exostosis was removed.
    I would want to use 28120-except- doc really does not specify WHICH bone the exostosis was removed from...talus or navicular?

    I would use this code because :
    A) i was taught this way (ha ha)(ok A is worthless)
    B) bossing is an excess growth of bone
    C)aaos code x - directs you to these codes for exostosis removal in the foot

    I know there has been some debate in the past in this forum - some people like to use the bone cyst/benign tumor codes.

  3. Question
    Do you think by doctor can bill for this as well? Also, I am curious to know why you do not agree with 28100 - Excision or curettage of bone cyst or benign tumor, talus or calcaneus.

    An arthrotomy of the talo-navicular joint was performed to expose the exostosis and insure no lose bodies were present in joint.

  4. #4
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    Quote Originally Posted by coders_rock! View Post
    Do you think by doctor can bill for this as well? Also, I am curious to know why you do not agree with 28100 - Excision or curettage of bone cyst or benign tumor, talus or calcaneus.

    An arthrotomy of the talo-navicular joint was performed to expose the exostosis and insure no lose bodies were present in joint.
    I do not agree with 28100 because of the reasons I stated above- my office follows medicare and AAOS guidelines(obviously we follow any comm. payor policy they may have in place as well). AAOS states the code sets 28120 ; 28122 ; 28124 are for exostosis removal in the foot (among other things) so that is what I use. I think there is AAOS dec 2003 bulletin stating this, I will double check/correct if I am wrong.

    As for the arthrotomy - I was assuming the surgery was performed to remove the exostosis, if so, I would consider the arthrotomy incidental....he had to do it in order to expose the exostosis.

    I would probably have asked my doc to correct his op report specifically stating WHICH bone the exostosis was removed from. He/she could potentially have a loss in charges if more than one was removed from different bones.

  5. Default
    I would not use 28100 because the exostosis is not a cyst, it is an overgrowth of bone, so I would use 28120.

    If it was a bone cyst, it would lie within the cavity of the bone and be fluid filled.

  6. Default
    The exostosis was actually removed from the joint. What CPT code do you suggest for this?

    Thanks!

  7. #7
    Default
    Quote Originally Posted by coders_rock! View Post
    The exostosis was actually removed from the joint. What CPT code do you suggest for this?

    Thanks!
    The exostosis HAD to be removed from a BONE, if it was inside a joint, it was still on one of the bones of the joint, you would need to know which bone he removed it from in order to code it correctly. It had to come off one or the other or both bones. If it was not attached to a bone, stuck in tendon,ligament, retinaculum, etc..... then it would be a loose/foreign body.

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