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Orthopedic Coding Alert

Reader Question:

Look to 28020 for I&D With Biopsy

Published on Wed Jul 14, 2004

Question: Our physician performed an incision and drainage (I&D) and a bone biopsy from the tarsometa-tarsal area. How should we report the biopsy? We considered 28050, but it refers to the joint, and our physician did not address the joint. Pennsylvania Subscriber Answer: If the I&D is the major procedure that the physician performs, you should report 28020 (Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint). Insurers consider the biopsy incidental to the I&D and will not separately reimburse you for it. If you report 28050 (Arthrotomy with biopsy; intertarsal or tarsometatarsal joint), not only would you be coding incorrectly but you would be leaving money on the table. Code 28020 reimburses about $520, whereas 28050 pays about $440 in many areas.
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