Podiatry Coding & Billing Alert

Hint: Make sure you know the exact size of the tumor.

When your podiatrist removes a tumor on a patient’s foot, toe, or ankle, you must check the medical documentation for numerous details including the size of the tumor, the depth of the tumor removal, and whether the podiatrist performed an excision or radical resection.

Read the following tips to keep your tumor removal claims in tip-top shape.

Tip 1: Rely on These Codes For Tumor Excision

If your podiatrist performs an excision, the surgical removal of a tumor, then he makes an incision as deep as or deeper than the full thickness of the skin. An excision requires suturing to allow the wound to heal.

When your podiatrist performs an excision of a tumor on the patient’s ankle, you will turn to these codes:

• 27618 (Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm)
• 27619 (… subfascial (eg, intramuscular); less than 5 cm)
• 27632 (… subcutaneous; 3 cm or greater)
• 27634 (… subfascial (eg, intramuscular); 5 cm or greater).

When you report foot or toe tumor excisions, look to the following codes:

• 28039 (Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater)
• 28041 (… subfascial (eg, intramuscular); 1.5 cm or greater)
• 28043 (… subcutaneous; less than 1.5 cm)
• 28045 (… subfascial (eg, intramuscular); less than 1.5 cm).

Coding example: The podiatrist excised an abnormal mass from the soft tissue below the skin in the patient’s left foot. The podiatrist then submitted the specimen, which was 1.5 cm in size, to a lab for analysis to determine its nature.

You should report 28039 for this service.

Tip 2: Put Radical Resection Options in Coding Arsenal

You may read in the medical documentation that your podiatrist performed radical resection of a tumor. Radical resection is the surgical removal of a structure to include its vascular supply, associated lymph nodes, and a sufficient margin of surrounding tissues, especially around a tumor, to ensure that all diseased tissue is removed. Radical resection generally applies to malignant tumors.

If the podiatrist performs radical resection of a tumor, such as a sarcoma, on a patient’s ankle, then you would report the following codes:

• 27615 (Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cm)
• 27616 (… 5 cm or greater).

On the other hand, if your podiatrist performs a radical resection of a foot or toe tumor, you should report the following codes:

• 28046 (Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cm)
• 28047 (… 3 cm or greater).

Coding example: The podiatrist makes an incision in the area of a suspected sarcoma on the patient’s ankle. He then raises skin flaps on either side and isolates the tumor. The podiatrist identifies any neurovascular structures that may require incision, and he attempts to preserve as many as possible. The podiatrist excises and removes the sarcoma en bloc, with a margin of tissue around the tumor included with the mass to ensure that no diseased tissue remains. The mass, along with the surrounding tissues and margins, measures 4 cm. The podiatrist submits the specimen for pathologic analysis. Finally, he irrigates the area, checks for bleeding, removes any instruments, and closes the incision.

You should report 27615 for this procedure.

Tip 3: Remember These Important Documentation Details

If your podiatrist specifies tumor removal, you must check the patient’s records for indications that the mass is musculoskeletal in origin, such as a reference to “soft tissue.”

You should also check the documentation to make sure that the podiatrist includes a physical description of the tumor, as well as the diameter, the depth, the level of the tissue he removed, the closure type, and if he sent it to pathology, says Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

To make sure you report the correct tumor removal procedure codes, ask the following questions as you read through the documentation:

• Question 1: What was the exact size of the tumor? All of the excision and radical resection codes listed above specify a certain size of tumor in their descriptor. For example, code 28043 would be a possible choice if the subcutaneous foot or toe tumor was less than 1.5 cm.
• Question 2: What was the depth of the tumor removal? Was it subcutaneous, subfascial, intramuscular, or deep? Note: Subcutaneous tissues are usually above deep fascia. When the podiatrist removes tissues below fascia, then he is getting into radical resections.
• Question 3: Did the podiatrist perform an excision or a radical resection? Note: One clue in your podiatrist’s documentation that would indicate a radical resection is the large area covered by the procedure.