Outpatient Facility Coding Alert

Question: How should we code for windowing the navicular and cuboid bones, with implanting of calcium sulfate beads impregnated with antibiotic? The beads are not the type that need to be removed, but someone told me I could bill 11981-11983 for this.

Ohio Subscriber

Answer: Code the windowing using 28005 (Incision, bone cortex [e.g., osteomyelitis or bone abscess], foot) with modifier 59 (Distinct procedural service) appended to indicate that both the navicular and cuboid bones were windowed. For example, the claim should list 28005 on the first line and 28005-59 on the second line.

The descriptor for code 11981 (Insertion, non-biodegradable drug delivery implant) refers to “non-biodegradable” drugs, and you have indicated that your antibiotic beads are biodegradable, so this code does not apply to your procedure. Under these circumstances, the insertion of the beads is not separately reimbursable.

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